Provider Demographics
NPI:1306018833
Name:JUDY, TERESA I (LCSW, LIMHP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:I
Last Name:JUDY
Suffix:
Gender:F
Credentials:LCSW, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 SPECKER AVE
Mailing Address - Street 2:BUILDING 1830
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4263
Mailing Address - Country:US
Mailing Address - Phone:719-503-7844
Mailing Address - Fax:719-503-7884
Practice Address - Street 1:6541 SPECKER AVE
Practice Address - Street 2:BUILDING 1830
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4263
Practice Address - Country:US
Practice Address - Phone:719-503-7829
Practice Address - Fax:719-503-7884
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1025101YM0800X
NE13991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1399OtherNEBRASKA DEPT OF HEALTH AND HUMAN SERVICES
NE1025OtherNEBRASKA DEPT OF HEALTH AND HUMAN SERVICES