Provider Demographics
NPI:1740444926
Name:CRAIN, TRACY E (LPC-S, LCDC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:E
Last Name:CRAIN
Suffix:
Gender:F
Credentials:LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WEST MILL VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-937-5504
Mailing Address - Fax:682-292-1380
Practice Address - Street 1:305 MIRON DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:682-233-2882
Practice Address - Fax:682-292-1380
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC 9238101YA0400X
TXLPC 19459101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162022101Medicaid