Healthcare Provider Details

I. General information

NPI: 1134789225
Provider Name (Legal Business Name): TESSA VETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date: 09/21/2020
Reactivation Date: 09/30/2020

III. Provider practice location address

1600 S LANE ST
SEATTLE WA
98144-2810
US

IV. Provider business mailing address

1600 S LANE ST
SEATTLE WA
98144-2810
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61066708
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: