Provider Demographics
NPI:1437480977
Name:TEASLEY, IRIS VANESSA (CADAC)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:VANESSA
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:CADAC
Other - Prefix:MISS
Other - First Name:IRIS
Other - Middle Name:VANESSA
Other - Last Name:TROTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 BERGQUIST DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-7702
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0427OtherU. S. AIR FORCE CERTIFIED ALCOHOL AND DRUG ABUSE COUNSELOR