Provider Demographics
NPI:1487765434
Name:KEATON, TRACY ANN (MS, PLPC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:KEATON
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E HIGHPOINT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2767
Mailing Address - Country:US
Mailing Address - Phone:417-890-5185
Mailing Address - Fax:
Practice Address - Street 1:2117 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2548
Practice Address - Country:US
Practice Address - Phone:417-885-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional