Provider Demographics
NPI:1295029874
Name:MCCORMICK, TERESA B (MHPP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:B
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 N REYNOLDS RD
Mailing Address - Street 2:STE 1
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2533
Mailing Address - Country:US
Mailing Address - Phone:501-847-0081
Mailing Address - Fax:501-847-6905
Practice Address - Street 1:2213 N REYNOLDS RD
Practice Address - Street 2:STE 1
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2533
Practice Address - Country:US
Practice Address - Phone:501-847-0081
Practice Address - Fax:501-847-6905
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator