Provider Demographics
NPI:1598244261
Name:HEISEY, TERI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:HEISEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6362
Mailing Address - Country:US
Mailing Address - Phone:919-638-6281
Mailing Address - Fax:
Practice Address - Street 1:1656 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4004
Practice Address - Country:US
Practice Address - Phone:307-577-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24555101YA0400X
WYPCSW-8071041C0700X
NC1041C0700X
WYLCSW-12851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)