Provider Demographics
NPI:1780360487
Name:LONG, TRACY ANN (MS, LPC, NCC, BC-TMH)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, LPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MENCHACA RD STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5374
Mailing Address - Country:US
Mailing Address - Phone:737-310-0009
Mailing Address - Fax:737-220-2313
Practice Address - Street 1:6708 BISHOP PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-6463
Practice Address - Country:US
Practice Address - Phone:737-310-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health