Healthcare Provider Details

I. General information

NPI: 1194464768
Provider Name (Legal Business Name): TRACY DAWN MARTIN PHD, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY DAWN PIERCE PHD, BCBA

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42124 VETERANS AVE
HAMMOND LA
70403-1427
US

IV. Provider business mailing address

135 W MYRTLE ST
MAGNOLIA MS
39652-2805
US

V. Phone/Fax

Practice location:
  • Phone: 985-500-3240
  • Fax:
Mailing address:
  • Phone: 214-687-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: