Provider Demographics
NPI:1003144163
Name:OLDHAM, TERESA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 SPEARS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1438
Mailing Address - Country:US
Mailing Address - Phone:254-541-0434
Mailing Address - Fax:
Practice Address - Street 1:80 MORGAN'S POINT RD.
Practice Address - Street 2:SUITE 105
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513
Practice Address - Country:US
Practice Address - Phone:254-831-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212516304Medicaid