Basic Information
| Provider Information | |||||||||
| NPI: | 1659682177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREILING | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 SW SCALEHOUSE LOOP | ||||||||
| Address2: | STE 204 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977021277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702715555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 SW SCALEHOUSE LOOP | ||||||||
| Address2: | STE 204 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977021277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413066456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS016811 | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.