Provider Demographics
NPI:1306593199
Name:BARRIOS, TRACI (LAC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:BARRIOS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 N VERONA LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6647
Mailing Address - Country:US
Mailing Address - Phone:918-471-3270
Mailing Address - Fax:
Practice Address - Street 1:2705 OAK LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4816
Practice Address - Country:US
Practice Address - Phone:479-471-5950
Practice Address - Fax:479-471-5997
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2202006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health