Provider Demographics
NPI:1669938668
Name:PLATT, TERESA (CO60745624)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:CO60745624
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:SORK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7017 NE HIGHWAY 99 STE 114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0554
Mailing Address - Country:US
Mailing Address - Phone:360-694-7484
Mailing Address - Fax:360-694-7479
Practice Address - Street 1:7017 NE HIGHWAY 99 STE 114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0554
Practice Address - Country:US
Practice Address - Phone:360-694-7484
Practice Address - Fax:360-694-7479
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821048869OtherOPEN