Provider Demographics
NPI:1114396058
Name:TRICOU, RENE
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:TRICOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 HORN LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2917
Mailing Address - Country:US
Mailing Address - Phone:458-201-9568
Mailing Address - Fax:
Practice Address - Street 1:53000 BREITENBUSH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:OR
Practice Address - Zip Code:97342-9703
Practice Address - Country:US
Practice Address - Phone:541-357-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0206321101YM0800X
ORC7580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health