Provider Demographics
NPI:1619588209
Name:SEBASTIAN, TERI (LMFT, LISAC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:LMFT, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S MONTEZUMA ST STE 201E
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4712
Mailing Address - Country:US
Mailing Address - Phone:928-224-5257
Mailing Address - Fax:
Practice Address - Street 1:240 S MONTEZUMA ST STE 201E
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4712
Practice Address - Country:US
Practice Address - Phone:928-224-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15160101YA0400X
AZ15413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)