Provider Demographics
NPI:1114629235
Name:TESCH, CAITLIN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:TESCH
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 1:202 BLUE BAYOU CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5684
Mailing Address - Country:US
Mailing Address - Phone:847-363-3104
Mailing Address - Fax:
Practice Address - Street 1:1900 MATLOCK RD # 2
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4391
Practice Address - Country:US
Practice Address - Phone:817-500-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical