Provider Demographics
NPI:1427420454
Name:TETT'S CONSULTANT
Entity type:Organization
Organization Name:TETT'S CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TETT
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED
Authorized Official - Phone:484-300-8699
Mailing Address - Street 1:1734 S CHADWICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:484-300-8699
Mailing Address - Fax:
Practice Address - Street 1:1734 S CHADWICK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:484-300-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH00589305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization