Individual
TRACY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
11EAGLE DR., VILONIA, AR 72173
(501) 412-4529
Mailing address
1 WHIPPOORWILL DR, VILONIA, AR 72173-9229
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P0210044
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y548
BCBS
AR
Enumeration date
09/06/2006
Last updated
07/08/2007
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