Provider Demographics
NPI:1942577911
Name:LETELLIER, ERIN M (LMHCA, LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:LETELLIER
Suffix:
Gender:F
Credentials:LMHCA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KNECHTEL WAY NE STE 203
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2834
Mailing Address - Country:US
Mailing Address - Phone:206-775-6877
Mailing Address - Fax:
Practice Address - Street 1:345 KNECHTEL WAY NE STE 203
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2834
Practice Address - Country:US
Practice Address - Phone:206-775-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60255388225700000X
WAMC60499240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist