Provider Demographics
NPI:1588627202
Name:MARSHALL, TERESA J (PHD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 S CIRCLE DR
Mailing Address - Street 2:STE 250L
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4132
Mailing Address - Country:US
Mailing Address - Phone:719-406-1223
Mailing Address - Fax:719-465-1394
Practice Address - Street 1:2860 S. CIRCLE DR
Practice Address - Street 2:STE 250L
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4132
Practice Address - Country:US
Practice Address - Phone:719-406-1223
Practice Address - Fax:719-465-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0001394103T00000X
CO1394103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07013949Medicaid
COR18894Medicare UPIN
CO07013949Medicaid