Healthcare Provider Details

I. General information

NPI: 1568501815
Provider Name (Legal Business Name): MONIQUE LYNN TETZLOFF MS, MHP, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE LYNN KLEIN

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 34TH AVE SW
SEATTLE WA
98126-4208
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-3164
  • Fax: 206-973-8786
Mailing address:
  • Phone: 206-548-3058
  • Fax: 206-262-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00043538
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00002688
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: