Provider Demographics
NPI:1477375657
Name:TETRA COUNSELING, LLC
Entity type:Organization
Organization Name:TETRA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BULLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:801-425-4333
Mailing Address - Street 1:1515 S L ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3946
Mailing Address - Country:US
Mailing Address - Phone:801-425-4333
Mailing Address - Fax:
Practice Address - Street 1:1515 S L ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3946
Practice Address - Country:US
Practice Address - Phone:801-425-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health