Provider Demographics
NPI:1164690186
Name:TERESA J MARSHALL PSYCHOLOGIAL SERVICES, LLC
Entity Type:Organization
Organization Name:TERESA J MARSHALL PSYCHOLOGIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-406-1223
Mailing Address - Street 1:2860 S CIRCLE DR.
Mailing Address - Street 2:STE 250L
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4132
Mailing Address - Country:US
Mailing Address - Phone:719-406-1223
Mailing Address - Fax:719-465-1394
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:STE 250L
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4132
Practice Address - Country:US
Practice Address - Phone:719-406-1223
Practice Address - Fax:719-465-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1394103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO387818Medicare PIN