Provider Demographics
NPI:1235363169
Name:ALVARADO, MARIA TERESA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TERESA
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:TERESA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:315 STAMPEDE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-6879
Mailing Address - Country:US
Mailing Address - Phone:208-821-7829
Mailing Address - Fax:
Practice Address - Street 1:315 STAMPEDE DR STE 203
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-6879
Practice Address - Country:US
Practice Address - Phone:208-821-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC4191101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCPC 4191Medicaid