Provider Demographics
NPI:1609250711
Name:BIEBEL, TRACEY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:BIEBEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:BIEBEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1829 NE ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5879
Mailing Address - Country:US
Mailing Address - Phone:503-929-1765
Mailing Address - Fax:
Practice Address - Street 1:4433 NE FAILING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1055
Practice Address - Country:US
Practice Address - Phone:503-929-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical