Provider Demographics
NPI:1790163194
Name:BLACK, TERESA SANCHEZ
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SANCHEZ
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 JUNIPINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-5649
Mailing Address - Country:US
Mailing Address - Phone:559-556-4748
Mailing Address - Fax:
Practice Address - Street 1:1401 N GREEN VALLEY PKWY STE 260
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7100
Practice Address - Country:US
Practice Address - Phone:559-556-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist