Provider Demographics
NPI:1164849824
Name:ADAMS- BALLEW, TEQUINA (LCSW)
Entity Type:Individual
Prefix:
First Name:TEQUINA
Middle Name:
Last Name:ADAMS- BALLEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 S REDWOOD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5449
Mailing Address - Country:US
Mailing Address - Phone:385-313-8305
Mailing Address - Fax:
Practice Address - Street 1:5663 S REDWOOD RD UNIT 2
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5449
Practice Address - Country:US
Practice Address - Phone:385-313-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT11305655-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor