Provider Demographics
NPI:1144760505
Name:TERESA GRELLA-HILLEBRAND, LICENSED MARRIAGE & FAMILY THERAPY P.C.
Entity Type:Organization
Organization Name:TERESA GRELLA-HILLEBRAND, LICENSED MARRIAGE & FAMILY THERAPY P.C.
Other - Org Name:LIFE STAGES COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRELLA-HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:631-327-2508
Mailing Address - Street 1:14 CANDLEWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5304
Mailing Address - Country:US
Mailing Address - Phone:631-327-2508
Mailing Address - Fax:
Practice Address - Street 1:14 CANDLEWOOD PATH
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5304
Practice Address - Country:US
Practice Address - Phone:631-327-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE STAGES COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000155-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty