MEDICARE: TETRA COUNSELING LLC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477375657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TETRA COUNSELING LLC

Provider Business Mailing Address
First Line	:	109 E HARRISON ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404-1554
Country	:	US
Telephone Number	:	253-260-5527
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 E HARRISON ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404-1554
Country	:	US
Telephone Number	:	801-425-4333
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER / OWNER
Name	:	CANDACE MICHELLE BULLINGER
Credential	:	LICSW
Telephone Number	:	801-425-4333

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	11/19/2025

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