Provider Demographics
NPI:1134735079
Name:BERGEN, TRECY
Entity type:Individual
Prefix:
First Name:TRECY
Middle Name:
Last Name:BERGEN
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 1:1304 FERNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1028
Mailing Address - Country:US
Mailing Address - Phone:828-482-2174
Mailing Address - Fax:
Practice Address - Street 1:612 W 22ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5104
Practice Address - Country:US
Practice Address - Phone:512-270-9084
Practice Address - Fax:682-651-1468
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008144363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health