Basic Information
| Provider Information | |||||||||
| NPI: | 1134735079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGEN | ||||||||
| FirstName: | TRECY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 604 ALLEN ST APT 103 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787024924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284822174 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4005 BANISTER LN STE 200C | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787048077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123287222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1008144 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.