Provider Demographics
NPI:1003404773
Name:THOMAS, TERESA M (CCSH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5033
Mailing Address - Country:US
Mailing Address - Phone:979-219-2421
Mailing Address - Fax:
Practice Address - Street 1:102 RIDGE CV
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5033
Practice Address - Country:US
Practice Address - Phone:979-219-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator