Provider Demographics
NPI:1659606283
Name:PARTIN, TERESA DIANE (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANE
Last Name:PARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DIANE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1901 CENTRAL DR
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5869
Mailing Address - Country:US
Mailing Address - Phone:817-685-8788
Mailing Address - Fax:817-685-8789
Practice Address - Street 1:1901 CENTRAL DR
Practice Address - Street 2:SUITE 506
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5869
Practice Address - Country:US
Practice Address - Phone:817-685-8788
Practice Address - Fax:817-685-8789
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60857OtherLPC