Provider Demographics
NPI:1558514844
Name:TETRAULT, MONICA M (LPC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:TETRAULT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 MAPLE AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6519
Mailing Address - Country:US
Mailing Address - Phone:214-351-6600
Mailing Address - Fax:214-351-5046
Practice Address - Street 1:5701 MAPLE AVE
Practice Address - Street 2:STE. 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6519
Practice Address - Country:US
Practice Address - Phone:214-351-6600
Practice Address - Fax:214-351-5046
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional