Individual
TRACIE VINETTE MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13524 ULYSSES S GRANT ST, MANOR, TX 78653-3941
(512) 542-4543
Mailing address
13524 ULYSSES S GRANT ST, MANOR, TX 78653-3941
(512) 542-4543
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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