Provider Demographics
NPI:1952433096
Name:MCNEELY, TRACY WEATHERFORD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:WEATHERFORD
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:WEATHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4591
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4591
Mailing Address - Country:US
Mailing Address - Phone:337-310-7378
Mailing Address - Fax:337-310-7382
Practice Address - Street 1:4820 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6010
Practice Address - Country:US
Practice Address - Phone:337-310-7378
Practice Address - Fax:337-310-7382
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4059OtherLICENSE-SOCIAL WORKER