Provider Demographics
NPI:1942549571
Name:KROUT-WATSON, TRACY LYNN (PSYS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:KROUT-WATSON
Suffix:
Gender:F
Credentials:PSYS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4628
Mailing Address - Country:US
Mailing Address - Phone:864-577-7500
Mailing Address - Fax:864-577-7621
Practice Address - Street 1:355 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4628
Practice Address - Country:US
Practice Address - Phone:864-577-7500
Practice Address - Fax:864-577-7621
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204050103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC204050OtherSC STATE BOARD OF EDUCATION EDUCATOR CERTIFICATE
32208OtherNATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST