Individual
TRACY RENEE MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
18 CR 458, MTN. HOME, AR 72653
(870) 425-3547
Mailing address
P.O BOX 1655, MTN. HOME, AR 72654
(870) 425-8149
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
P0603017
AR
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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