Provider Demographics
NPI:1720857337
Name:SCHMECK, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:SCHMECK
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 1:1738 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4616
Mailing Address - Country:US
Mailing Address - Phone:541-892-4929
Mailing Address - Fax:
Practice Address - Street 1:901 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-5810
Practice Address - Country:US
Practice Address - Phone:541-238-2289
Practice Address - Fax:541-835-3322
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR23-QMHA-R-4331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator