Provider Demographics
NPI:1558877696
Name:PICKET FENE THERAPY & CONSULTING, LLC
Entity Type:Organization
Organization Name:PICKET FENE THERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-310-6226
Mailing Address - Street 1:11515 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8543
Mailing Address - Country:US
Mailing Address - Phone:253-310-6226
Mailing Address - Fax:855-946-8249
Practice Address - Street 1:105B W MAIN STE 105
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5329
Practice Address - Country:US
Practice Address - Phone:253-310-6226
Practice Address - Fax:253-604-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty