Provider Demographics
NPI:1255900742
Name:KRIDER, TRACI (LPC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:KRIDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1715
Mailing Address - Country:US
Mailing Address - Phone:814-329-6216
Mailing Address - Fax:814-472-0679
Practice Address - Street 1:411 N MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1431
Practice Address - Country:US
Practice Address - Phone:814-695-2200
Practice Address - Fax:814-695-2204
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional