Provider Demographics
NPI:1386217842
Name:HOLMBERG, TERESA RHAY (BS, AAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:RHAY
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:BS, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16307 NE83RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-968-5921
Mailing Address - Fax:
Practice Address - Street 1:2204 186TH PL SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8710
Practice Address - Country:US
Practice Address - Phone:425-319-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor