Provider Demographics
NPI:1114305786
Name:SHERRON-SPIES, TRACEY NICHOLE (LMFT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:NICHOLE
Last Name:SHERRON-SPIES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:NICHOLE
Other - Last Name:SPIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5311 REDDOCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4611
Mailing Address - Country:US
Mailing Address - Phone:903-715-2603
Mailing Address - Fax:
Practice Address - Street 1:1515 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3154
Practice Address - Country:US
Practice Address - Phone:903-715-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
OK10056106H00000X
MST10903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator