Basic Information
| Provider Information | |||||||||
| NPI: | 1467928366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TETUH | ||||||||
| FirstName: | CAREEN | ||||||||
| MiddleName: | ENDAM | ||||||||
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| Credential: | |||||||||
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| OtherLastName: | TETUH | ||||||||
| OtherFirstName: | CAREEN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PMHNP-BC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6430 COURT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770534462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325391416 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12505 MEMORIAL DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770246051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448248775 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP145233 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.