Provider Demographics
NPI:1235559949
Name:BLAUERSOUTH, TERI (MA)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:BLAUERSOUTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 294
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2897
Mailing Address - Country:US
Mailing Address - Phone:612-430-7558
Mailing Address - Fax:
Practice Address - Street 1:1508 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2157
Practice Address - Country:US
Practice Address - Phone:612-871-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health