Provider Demographics
NPI:1659094688
Name:TECCA, TODD MICHAEL (CBHPSS/LIFE COACH)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:TECCA
Suffix:
Gender:M
Credentials:CBHPSS/LIFE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-9106
Mailing Address - Country:US
Mailing Address - Phone:406-202-2289
Mailing Address - Fax:
Practice Address - Street 1:3604 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-9106
Practice Address - Country:US
Practice Address - Phone:406-202-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach