| Doctor Name: | TRACEY MICHELLE MARK-BOSTON |
| NPI Number: | 1134164254 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C3690 |
| Business Practice Address: | 703 W Canal St Picayune, MS - 394663918 |
| Business Phone Number: | 6017499477 |
| Business Fax Number: | |
| Mailing Address: | 2314 Walker St, PICAYUNE |
| State: | MS |
| Postal Code: | 394663066 |
| Phone Number: | 2282342918 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2006 |
| NPI Last Update Date: | 02/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C3690 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |