Basic Information
| Provider Information | |||||||||
| NPI: | 1124182241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREBS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 777 | ||||||||
| Address2: | |||||||||
| City: | PARSONSFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | OS922 | ME | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 000582 | CT | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 004751 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.