Provider Demographics
NPI:1164752093
Name:LEWIS-TESKEY, TERESA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:LEWIS-TESKEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:DRAGONETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5540 E BROADWAY RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1440
Mailing Address - Country:US
Mailing Address - Phone:480-830-8299
Mailing Address - Fax:480-830-1820
Practice Address - Street 1:5540 E BROADWAY RD
Practice Address - Street 2:SUITE 13
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1440
Practice Address - Country:US
Practice Address - Phone:480-830-8299
Practice Address - Fax:480-830-1820
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-25
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health