Provider Demographics
NPI:1659682177
Name:KREILING, TRACY N (PSYD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:N
Last Name:KREILING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SW SCALEHOUSE LOOP
Mailing Address - Street 2:STE 204
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1277
Mailing Address - Country:US
Mailing Address - Phone:570-271-5555
Mailing Address - Fax:
Practice Address - Street 1:231 SW SCALEHOUSE LOOP
Practice Address - Street 2:STE 204
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1277
Practice Address - Country:US
Practice Address - Phone:541-306-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist