Provider Demographics
NPI:1205137072
Name:TEUFEL, MITCHELL WILLIAM (MA ABS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:WILLIAM
Last Name:TEUFEL
Suffix:
Gender:M
Credentials:MA ABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 NE 124TH ST # 410
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4305
Mailing Address - Country:US
Mailing Address - Phone:206-325-6296
Mailing Address - Fax:
Practice Address - Street 1:11521 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3026
Practice Address - Country:US
Practice Address - Phone:206-325-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60152504103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst