Individual
MS. DIANE M TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LCMHC
Contact information
Practice address
138 MAIN ST, MONTPELIER, VT 05602
(802) 229-1643
(802) 229-1643
Mailing address
138 MAIN ST, MONTPELIER, VT 05602
(802) 229-1643
(802) 229-1643
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0680000627
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068835
BCBS MAGELEN
VT
05
—
1011810
—
VT
01
—
2316710
CIGNA BEHAVIORAL H
VT
01
—
389311
MVP
—
01
—
581232
GREAT WEST VALUE OPTIONS
—
Enumeration date
02/09/2007
Last updated
07/08/2007
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