Provider Demographics
NPI:1700017928
Name:TRIBETT, TERESA IRENE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:IRENE
Last Name:TRIBETT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 WINDLAKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5022
Mailing Address - Country:US
Mailing Address - Phone:210-535-5650
Mailing Address - Fax:
Practice Address - Street 1:620 E AFTON OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1236
Practice Address - Country:US
Practice Address - Phone:210-568-8612
Practice Address - Fax:210-490-9430
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional