Basic Information
| Provider Information | |||||||||
| NPI: | 1154602571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGROW | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 20TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257032071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911500 | ||||||||
| FaxNumber: | 3045234358 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 20TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257032071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911500 | ||||||||
| FaxNumber: | 3045234358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1004 | WV | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.