Provider Demographics
NPI:1699815621
Name:ELTRICH, TERESA M (MS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:ELTRICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8543
Mailing Address - Country:US
Mailing Address - Phone:253-310-6226
Mailing Address - Fax:855-946-8249
Practice Address - Street 1:11515 BURNHAM DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8543
Practice Address - Country:US
Practice Address - Phone:253-310-6226
Practice Address - Fax:855-946-8249
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00045887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health