Provider Demographics
NPI:1811006687
Name:STARCK, TERESA LOUISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LOUISE
Last Name:STARCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LOUISE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4800
Mailing Address - Fax:970-207-4805
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:970-207-4805
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22686045Medicaid