Provider Demographics
NPI:1093892184
Name:BELTRAN, THERESA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:BELTRAN
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 1:13065 W MCDOWELL RD
Mailing Address - Street 2:SUITE C-113
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6439
Mailing Address - Country:US
Mailing Address - Phone:602-403-1742
Mailing Address - Fax:623-398-8488
Practice Address - Street 1:13065 W MCDOWELL RD
Practice Address - Street 2:SUITE C-113
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6439
Practice Address - Country:US
Practice Address - Phone:602-403-1742
Practice Address - Fax:623-398-8488
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-23201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical