Provider Demographics
NPI:1255085510
Name:CARTER, TRACY LEIGH (LPC-A)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 SIERRA OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2039
Mailing Address - Country:US
Mailing Address - Phone:210-364-7424
Mailing Address - Fax:
Practice Address - Street 1:6627 SIERRA OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2039
Practice Address - Country:US
Practice Address - Phone:210-364-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional