Provider Demographics
NPI:1477962447
Name:DAVIDSON, TERESA (MFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33029 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8485
Mailing Address - Country:US
Mailing Address - Phone:812-297-8020
Mailing Address - Fax:
Practice Address - Street 1:33029 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8485
Practice Address - Country:US
Practice Address - Phone:281-297-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001295106H00000X
TX202869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist