Provider Demographics
NPI:1568415024
Name:ALLARA, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ALLARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:1311 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-765-2605
Practice Address - Fax:270-234-8572
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000044434OtherANTHEM
KY341168OtherTRICARE
11489585OtherCAQH
KY30605018Medicaid
KY0026675Medicare PIN
S28457Medicare UPIN
KY0763534Medicare ID - Type UnspecifiedMEDICARE
KY0026675Medicare PIN
KY0359217Medicare ID - Type UnspecifiedMEDICARE
KY341168OtherTRICARE
S28457Medicare UPIN
KY0762334Medicare ID - Type UnspecifiedMEDICARE