Provider Demographics
NPI:1134387566
Name:TRAUGOTT, TRACY ELIZABETH (MS, LPC, LSOTP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ELIZABETH
Last Name:TRAUGOTT
Suffix:
Gender:F
Credentials:MS, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 ARABIAN GATE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5958
Mailing Address - Country:US
Mailing Address - Phone:210-263-9018
Mailing Address - Fax:
Practice Address - Street 1:1115 MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-4505
Practice Address - Country:US
Practice Address - Phone:210-533-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional