Provider Demographics
NPI:1790559961
Name:TEESE, CHLOE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:TEESE
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 1:840 SQUAW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-4705
Mailing Address - Country:US
Mailing Address - Phone:916-872-0349
Mailing Address - Fax:
Practice Address - Street 1:9400 GATEWAY DR STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8907
Practice Address - Country:US
Practice Address - Phone:916-872-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician