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General NPI Number Information
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NPI Number | 1285898700
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Entity Type | Individual
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Provider Name | TRACY LEE MARSHALL LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 2153 E JOYCE BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4714
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Country | US
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Telephone | 479-575-9741
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Fax |
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Provider Business Mailing Address
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Address Line | 2153 E JOYCE BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4714
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Country | US
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Telephone | 479-575-9741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0803029
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License Number State | AR
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