Provider Demographics
NPI:1598403362
Name:WOLFORD, THERESA MARIE (LMHP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SIMMS AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0578
Mailing Address - Country:US
Mailing Address - Phone:402-850-1843
Mailing Address - Fax:712-323-4664
Practice Address - Street 1:1030 SIMMS AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0578
Practice Address - Country:US
Practice Address - Phone:402-850-1843
Practice Address - Fax:712-323-4664
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health