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NPI Code Detail

MEDICARE: MR. GEORGE LORNE TETREAULT

MEDICARE: MR. GEORGE LORNE TETREAULT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP2766MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306940333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE LORNE TETREAULT
Provider Business Mailing Address
First Line : 823 MAPLE ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3770
Country : US
Telephone Number : 833-316-0698
Fax Number :
Provider Business Practice Location Address
First Line : 823 MAPLE ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3770
Country : US
Telephone Number : 833-316-0698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2006
Last Update Date : 11/08/2022

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Directions to “ MR. GEORGE LORNE TETREAULT ” Practice Location

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