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General NPI Number Information
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NPI Number | 1104136647
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Entity Type | Organization
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Legal Business Name | TETRICK COUNSELING, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 2020 E ROBINSON ST
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City | ORLANDO
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State | FL
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Zip | 32803-6045
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Country | US
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Telephone | 407-929-6821
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Fax | 407-898-2805
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Provider Business Mailing Address
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Address Line | 1223 LAKE HIGHLAND DR
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City | ORLANDO
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State | FL
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Zip | 32803-2601
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Country | US
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Telephone | 407-929-6821
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Fax | 407-898-2805
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Authorized Official
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Title or Position | OWNER
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Name | MARTINA TETRICK
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Credential | LMHC
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Telephone | 407-929-6821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH7529
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License Number State | FL
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