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TRACY RENEE MATLOCK LPC

>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1174641278

Individual Registrant:
 TRACY RENEE MATLOCK LPC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
18 CR 458  MTN. HOME, AR 72653 US
Tel: 870-425-3547  Fax: --

Contact information for business:
P.O BOX 1655  MTN. HOME, AR 72654 US
Tel: 870-425-8149  Fax: --

Registration Information:
NPI: 1174641278
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers
Counselor
ARP0603017

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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