Provider Demographics
NPI:1881361608
Name:HILLER, TRACI
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:HILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24200 SOUTHWEST FWY STE 402-108
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5984
Mailing Address - Country:US
Mailing Address - Phone:480-442-8522
Mailing Address - Fax:
Practice Address - Street 1:24200 SOUTHWEST FWY STE 402-108
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5984
Practice Address - Country:US
Practice Address - Phone:480-442-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical