Individual
TRACEY LYNN COLACICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
2577 NE COURTNEY DR, BEND, OR 97701-7638
(541) 322-7500
Mailing address
2577 NE COURTNEY DR, BEND, OR 97701-7638
(541) 322-7500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C4196
OR
Other
Enumeration date
07/09/2008
Last updated
07/28/2016
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