Healthcare Provider Details

I. General information

NPI: 1578089546
Provider Name (Legal Business Name): TABITHA GAIL TEEPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY
SEATTLE WA
98122-5229
US

IV. Provider business mailing address

3001 E UNION ST
SEATTLE WA
98122-3252
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2000
  • Fax:
Mailing address:
  • Phone: 210-426-4057
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61113999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: