Provider Demographics
NPI:1215495460
Name:WATSON, TRACY LYNN PAYTON (LPC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN PAYTON
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 GREENVILLE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7148
Mailing Address - Country:US
Mailing Address - Phone:469-855-5883
Mailing Address - Fax:
Practice Address - Street 1:8604 GREENVILLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7148
Practice Address - Country:US
Practice Address - Phone:469-855-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty