Healthcare Provider Details

I. General information

NPI: 1073723193
Provider Name (Legal Business Name): TRACY LEVON TOWNSEND LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 S PACHECO ST STE 100
SANTA FE NM
87505-6478
US

IV. Provider business mailing address

PO BOX 10182
SANTA FE NM
87504-6182
US

V. Phone/Fax

Practice location:
  • Phone: 512-633-7505
  • Fax:
Mailing address:
  • Phone: 505-984-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17526
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0131391
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: