Provider Demographics
NPI:1144208745
Name:STEELE, THERESA TUCKER (PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:TUCKER
Last Name:STEELE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYLA
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1061 HARMON AVE, STE. 1D03
Mailing Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5674
Mailing Address - Country:US
Mailing Address - Phone:912-767-7301
Mailing Address - Fax:912-767-7303
Practice Address - Street 1:1061 HARMON AVE, STE. 1D03
Practice Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5674
Practice Address - Country:US
Practice Address - Phone:912-767-7301
Practice Address - Fax:912-767-7303
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2798103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0454UOtherBCBS PRIVATE PRACTICE
NCD6944OtherMEDCOST PRIVATE PRACTICE
NC046RUOtherBCBS
NC6000461Medicaid
NC6000699Medicaid
NC2492749AMedicare ID - Type Unspecified
NC046RUOtherBCBS