Individual
KANDI TETLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2524 FIRST AVE, KETCHIKAN, AK 99901-5804
(907) 225-4664
Mailing address
PO BOX 7475, KETCHIKAN, AK 99901-2475
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1703638
—
AK
05
—
1713721
—
AK
Enumeration date
02/17/2025
Last updated
02/17/2025
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