Provider Demographics
NPI:1982185351
Name:EICHIN, TRACI L (LCDC, LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:EICHIN
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-4514
Mailing Address - Country:US
Mailing Address - Phone:325-374-8929
Mailing Address - Fax:
Practice Address - Street 1:4721 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-4514
Practice Address - Country:US
Practice Address - Phone:325-374-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional