Provider Demographics
NPI:1326067810
Name:TREADWAY-TERAN, RICK (LMFT-SUPERVISOR)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:TREADWAY-TERAN
Suffix:
Gender:M
Credentials:LMFT-SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-0991
Mailing Address - Country:US
Mailing Address - Phone:512-430-0540
Mailing Address - Fax:
Practice Address - Street 1:6448 E HIGHWAY 290
Practice Address - Street 2:BUILDING E, SUITE 113
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1068
Practice Address - Country:US
Practice Address - Phone:512-430-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40138106H00000X
TX201227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982498Medicaid