Provider Demographics
NPI:1598916231
Name:CONNELL, TERESA JAYNE (LPC-S, ATR-BC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JAYNE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LPC-S, ATR-BC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4906
Mailing Address - Country:US
Mailing Address - Phone:512-459-3353
Mailing Address - Fax:512-459-1658
Practice Address - Street 1:3804 AVENUE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4906
Practice Address - Country:US
Practice Address - Phone:512-459-3353
Practice Address - Fax:512-459-1658
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional