Healthcare Provider Details

I. General information

NPI: 1447160783
Provider Name (Legal Business Name): TRACEY BAXTER P-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 SUNSET DR
GRENADA MS
38901-4079
US

IV. Provider business mailing address

8652 COUNTY ROAD 31
VAIDEN MS
39176-5034
US

V. Phone/Fax

Practice location:
  • Phone: 662-340-5947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP-1263
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: