Healthcare Provider Details

I. General information

NPI: 1942577911
Provider Name (Legal Business Name): ERIN M LETELLIER LMHCA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 KNECHTEL WAY NE STE 203
BAINBRIDGE ISLAND WA
98110-2834
US

IV. Provider business mailing address

345 KNECHTEL WAY NE STE 203
BAINBRIDGE ISLAND WA
98110-2834
US

V. Phone/Fax

Practice location:
  • Phone: 206-775-6877
  • Fax:
Mailing address:
  • Phone: 206-775-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60499240
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60255388
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: