Provider Demographics
NPI:1730144098
Name:ORMAN, TERESA ELISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELISE
Last Name:ORMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:ORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:SUITE 13 B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-892-9355
Mailing Address - Fax:512-266-3094
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:SUITE 13 B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-892-9355
Practice Address - Fax:512-266-3094
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K92HMedicare ID - Type Unspecified
TX00K92HMedicare UPIN
TX029485Medicare UPIN
TX79484595Medicare UPIN