Provider Demographics
NPI:1982035630
Name:TERESA COLLETT, LLC.
Entity Type:Organization
Organization Name:TERESA COLLETT, LLC.
Other - Org Name:ACCOUNTABLE FUTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-868-6952
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD
Mailing Address - Street 2:SUITE #211
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8514
Mailing Address - Country:US
Mailing Address - Phone:888-868-6952
Mailing Address - Fax:360-362-7492
Practice Address - Street 1:3208 50TH STREET CT NW
Practice Address - Street 2:BLDG. C SUITE #200
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8590
Practice Address - Country:US
Practice Address - Phone:888-868-6952
Practice Address - Fax:360-362-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603121773251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health