Provider Demographics
NPI:1871948463
Name:DE LA TORRE, TENILLE (PSYD)
Entity type:Individual
Prefix:
First Name:TENILLE
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 COFFEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1371
Mailing Address - Country:US
Mailing Address - Phone:307-369-3910
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DRIVE
Practice Address - Street 2:BLDG 160
Practice Address - City:F.E. WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3913
Practice Address - Country:US
Practice Address - Phone:307-773-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY820103T00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist