Provider Demographics
NPI:1215125497
Name:PERRY, TRACI ALISIA (LCSW)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:ALISIA
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ALISIA
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3810 COVE RD
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5554
Mailing Address - Country:US
Mailing Address - Phone:214-293-5294
Mailing Address - Fax:
Practice Address - Street 1:320 DECKER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8162
Practice Address - Country:US
Practice Address - Phone:972-719-2520
Practice Address - Fax:972-793-8957
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical