Provider Demographics
NPI:1528210713
Name:SIPOS, TERESA DURBAK (RN, MSED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DURBAK
Last Name:SIPOS
Suffix:
Gender:F
Credentials:RN, MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 STONEYCREEK CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8438
Mailing Address - Country:US
Mailing Address - Phone:614-364-2103
Mailing Address - Fax:
Practice Address - Street 1:1180 STONEYCREEK CT
Practice Address - Street 2:TRINITY COUNSELING
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8438
Practice Address - Country:US
Practice Address - Phone:740-652-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1902101YP2500X
OHRN 169317163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health