Provider Demographics
NPI:1942270160
Name:REGARD, TRACY NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:NICOLE
Last Name:REGARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 HIGHWAY 1192
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-3801
Mailing Address - Country:US
Mailing Address - Phone:318-359-0041
Mailing Address - Fax:318-240-7293
Practice Address - Street 1:221 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2311
Practice Address - Country:US
Practice Address - Phone:318-240-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385905Medicaid
LA4C857Medicare PIN