Provider Demographics
NPI:1982143152
Name:CHATAT, TRACY LEIGH (MSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:CHATAT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 COUNTY ROAD 450
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-7713
Mailing Address - Country:US
Mailing Address - Phone:573-718-1901
Mailing Address - Fax:573-686-1029
Practice Address - Street 1:1600 WEST MAUD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8685
Practice Address - Country:US
Practice Address - Phone:573-872-4798
Practice Address - Fax:573-872-4797
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor