Provider Demographics
NPI:1124045653
Name:MARSH, THERESA J (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:MARSH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 SOUTH HILLSIDE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4005
Mailing Address - Country:US
Mailing Address - Phone:316-687-0006
Mailing Address - Fax:316-687-0328
Practice Address - Street 1:1148 SOUTH HILLSIDE
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4005
Practice Address - Country:US
Practice Address - Phone:316-687-0006
Practice Address - Fax:316-687-0328
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW07901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066014OtherBLUE CROSS BLUE SHIELD
KS066014OtherBLUE CROSS BLUE SHIELD
R76140Medicare UPIN