Provider Demographics
NPI:1609576776
Name:HENDRICKSON, TEDDI JOELLE (MA, LMHC, NCC, PMH-C)
Entity Type:Individual
Prefix:
First Name:TEDDI
Middle Name:JOELLE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MA, LMHC, NCC, PMH-C
Other - Prefix:
Other - First Name:TEDDI
Other - Middle Name:JOELLE
Other - Last Name:CRIPPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4122 E PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5364
Mailing Address - Country:US
Mailing Address - Phone:509-362-5201
Mailing Address - Fax:
Practice Address - Street 1:705 W 7TH AVE STE E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2836
Practice Address - Country:US
Practice Address - Phone:509-362-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61202255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043764368OtherTYPE 2 NPI FOR MY LLC THAT I AM AN EMPLOYEE OF