Provider Demographics
NPI:1255845616
Name:ALLEN, TERESHA KAYE (CADC)
Entity Type:Individual
Prefix:
First Name:TERESHA
Middle Name:KAYE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 KINGMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3516
Mailing Address - Country:US
Mailing Address - Phone:515-661-5869
Mailing Address - Fax:515-255-2359
Practice Address - Street 1:4014 KINGMAN BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3516
Practice Address - Country:US
Practice Address - Phone:515-661-5869
Practice Address - Fax:515-255-2359
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)