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General NPI Number Information
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NPI Number | 1831712736
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Entity Type | Individual
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Provider Name | ROBERT TEISTER MFT
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Gender | Male
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 29617 156TH AVE E
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City | GRAHAM
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State | WA
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Zip | 98338-7441
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Country | US
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Telephone | 415-328-2719
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Fax |
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Provider Business Mailing Address
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Address Line | 29617 156TH AVE E
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City | GRAHAM
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State | WA
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Zip | 98338-7441
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Country | US
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Telephone | 415-328-2719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60323811
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License Number State | WA
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