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NPI Code Detail

MEDICARE: ALEXANDRA IOANA TETER MFT INTERN

MEDICARE: ALEXANDRA IOANA TETER MFT INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1740489467
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA IOANA TETER MFT INTERN
Provider Business Mailing Address
First Line : 584 KENTUCKY AVE
Second Line :
City : WOODLAND
State : CA
Zip : 95695-2779
Country : US
Telephone Number : 530-661-3213
Fax Number :
Provider Business Practice Location Address
First Line : 584 KENTUCKY AVE
Second Line :
City : WOODLAND
State : CA
Zip : 95695-2779
Country : US
Telephone Number : 530-661-3213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2007
Last Update Date : 09/20/2010

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Directions to “ ALEXANDRA IOANA TETER MFT INTERN” Practice Location

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