Provider Demographics
NPI:1811547979
Name:THURWANGER, TERESSA
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:
Last Name:THURWANGER
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 1:11725 S SHANNAN ST APT 809
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3753
Mailing Address - Country:US
Mailing Address - Phone:913-485-7674
Mailing Address - Fax:
Practice Address - Street 1:4110 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2303
Practice Address - Country:US
Practice Address - Phone:913-485-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist