MEDICARE: TRACI LEE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	5205	TX

General Provider Information

NPI Number	:	1609880244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI LEE PH.D.

Provider Business Mailing Address
First Line	:	2606 STATE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2600
Country	:	US
Telephone Number	:	214-552-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 STATE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204
Country	:	US
Telephone Number	:	214-552-5442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/09/2018

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