Provider Demographics
NPI:1497081244
Name:WARD, TRACY KEATING (LPC,)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:KEATING
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 PINKNEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1636
Mailing Address - Country:US
Mailing Address - Phone:512-288-6583
Mailing Address - Fax:512-288-6583
Practice Address - Street 1:1007 MOPAC CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6864
Practice Address - Country:US
Practice Address - Phone:512-426-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional