Provider Demographics
NPI:1134556640
Name:WAIBLE, TRACY J (LCSW, LCAC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:J
Last Name:WAIBLE
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:J
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LCAC
Mailing Address - Street 1:5101 E US HIGHWAY 36 STE 100
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6646
Mailing Address - Country:US
Mailing Address - Phone:888-714-1927
Mailing Address - Fax:317-745-9565
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:317-247-8935
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006088A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical