1942549571 NPI number — MRS. TRACY LYNN KROUT-WATSON PSY.S., NCSP

Table of content: MRS. TRACY LYNN KROUT-WATSON PSY.S., NCSP (NPI 1942549571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942549571 NPI number — MRS. TRACY LYNN KROUT-WATSON PSY.S., NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KROUT-WATSON
Provider First Name:
TRACY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PSY.S., NCSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942549571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 CEDAR SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29302-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-577-7500
Provider Business Mailing Address Fax Number:
864-577-7621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 CEDAR SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29302-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-577-7500
Provider Business Practice Location Address Fax Number:
864-577-7621
Provider Enumeration Date:
02/01/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  204050 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 204050 . This is a "SC STATE BOARD OF EDUCATION EDUCATOR CERTIFICATE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 32208 . This is a "NATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST" identifier . This identifiers is of the category "OTHER".