1881812840 NPI number — MRS. AMY MARIE TETALMAN M.A., MFT

Table of content: MRS. AMY MARIE TETALMAN M.A., MFT (NPI 1881812840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881812840 NPI number — MRS. AMY MARIE TETALMAN M.A., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETALMAN
Provider First Name:
AMY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENZ
Provider Other First Name:
AMY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881812840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 ROSARIO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93110-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-636-5366
Provider Business Mailing Address Fax Number:
805-681-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 ENCINA RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GOLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93117-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-681-0035
Provider Business Practice Location Address Fax Number:
805-681-0029
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  IMF 56685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 84544 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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