Provider Demographics
NPI:1811384605
Name:KREIS, TONYA (MED)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:KREIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0151
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-865-2064
Practice Address - Street 1:217 S TOPPENISH AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1780
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:509-865-2064
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60138919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health