Provider Demographics
NPI:1609098151
Name:TEAKWOOD PSYCHOLOGICAL RESOURCES, P.A.
Entity Type:Organization
Organization Name:TEAKWOOD PSYCHOLOGICAL RESOURCES, P.A.
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHNACKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-841-6446
Mailing Address - Street 1:1415 JAYHAWK BLVD FRASER 340
Mailing Address - Street 2:UNIVERSITY OF KANSAS
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045
Mailing Address - Country:US
Mailing Address - Phone:785-864-4121
Mailing Address - Fax:
Practice Address - Street 1:2201 W 25TH STREET
Practice Address - Street 2:SUITE 0
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047
Practice Address - Country:US
Practice Address - Phone:785-841-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty