=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861544512
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY DIANNE NEWTON M.ED., LPC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201.5 E. VIRGINIA SUITE 4
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-274-9934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 REGENT'S PARK
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-274-9934
-----------------------------------------------------
Fax | 972-542-5366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 14092
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------