Provider Demographics
NPI:1033318134
Name:COLLETT, TERESA DIANE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:DIANE
Last Name:COLLETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD
Mailing Address - Street 2:#211
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-692-1014
Mailing Address - Fax:360-362-7492
Practice Address - Street 1:3215 NW LOWELL ST
Practice Address - Street 2:SUITE #191
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-692-1014
Practice Address - Fax:360-362-7492
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002548106H00000X
CAMFC42554106H00000X
WAPSY60107671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist