Healthcare Provider Details

I. General information

NPI: 1992272389
Provider Name (Legal Business Name): TEGAN MICHL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

9040 FITZSIMMONS DR
JOINT BASE LEWIS MCCHORD WA
98431-1000
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5231
  • Fax:
Mailing address:
  • Phone: 253-968-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61035725
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: