Provider Demographics
NPI:1326025131
Name:ROSS, TERESA D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:D
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 SEASIDE AVE APT 2820
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-5533
Mailing Address - Country:US
Mailing Address - Phone:202-534-2966
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:ATTN: MCHK-FM, 1 JARRETT WHITE ROAD
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-5270
Practice Address - Fax:808-433-1153
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical