Provider Demographics
NPI:1144799172
Name:MINOR, TESHIRA GRAY (BS IN EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:TESHIRA
Middle Name:GRAY
Last Name:MINOR
Suffix:
Gender:F
Credentials:BS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 ROYCE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-5712
Mailing Address - Country:US
Mailing Address - Phone:318-730-2296
Mailing Address - Fax:
Practice Address - Street 1:1030 ROYCE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-5712
Practice Address - Country:US
Practice Address - Phone:318-730-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007213816101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health