Provider Demographics
NPI:1376167270
Name:GREGERSEN, TERESA LYNN (NLC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:GREGERSEN
Suffix:
Gender:F
Credentials:NLC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NLC
Mailing Address - Street 1:4691 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2262
Mailing Address - Country:US
Mailing Address - Phone:303-834-7496
Mailing Address - Fax:
Practice Address - Street 1:1455 DIXON AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8879
Practice Address - Country:US
Practice Address - Phone:720-406-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)