Provider Demographics
NPI:1114624079
Name:TEATALKSTHERAPY, PLLC
Entity Type:Organization
Organization Name:TEATALKSTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTREVISA
Authorized Official - Middle Name:LIZZIE
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-890-2678
Mailing Address - Street 1:21750 HARDY OAK BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4946
Mailing Address - Country:US
Mailing Address - Phone:601-890-2678
Mailing Address - Fax:210-960-9539
Practice Address - Street 1:1409 ARGYLL PARK
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3517
Practice Address - Country:US
Practice Address - Phone:601-890-2678
Practice Address - Fax:210-960-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health