Provider Demographics
NPI:1568222933
Name:TETTELBACH, COLLY (RN, MS, MA, CPE)
Entity Type:Individual
Prefix:
First Name:COLLY
Middle Name:
Last Name:TETTELBACH
Suffix:
Gender:F
Credentials:RN, MS, MA, CPE
Other - Prefix:
Other - First Name:COLLY
Other - Middle Name:
Other - Last Name:MCHENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8545 CARMEL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-9556
Mailing Address - Country:US
Mailing Address - Phone:831-626-4548
Mailing Address - Fax:831-625-9827
Practice Address - Street 1:8545 CARMEL VALLEY RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-9556
Practice Address - Country:US
Practice Address - Phone:831-626-4548
Practice Address - Fax:831-625-9827
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral