Provider Demographics
NPI:1306396742
Name:BERNING, TRACY CURTIS I (CADC I)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:CURTIS
Last Name:BERNING
Suffix:I
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:CURTIS
Other - Last Name:BERNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC I
Mailing Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:847 NE 19TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2684
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)