Provider Demographics
NPI:1578379459
Name:FRECKLETON, TRACY LYNNE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNNE
Last Name:FRECKLETON
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 1:18071 VIKING WAY NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8277
Mailing Address - Country:US
Mailing Address - Phone:360-710-4347
Mailing Address - Fax:
Practice Address - Street 1:3888 NW RANDALL WAY STE 201
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7847
Practice Address - Country:US
Practice Address - Phone:360-698-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health