Provider Demographics
NPI:1831552686
Name:MARANT, TRACI (LPC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:MARANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1524 S IH 35 STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2603
Mailing Address - Country:US
Mailing Address - Phone:512-343-8606
Mailing Address - Fax:
Practice Address - Street 1:1524 S IH 35 STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2603
Practice Address - Country:US
Practice Address - Phone:512-343-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional