Provider Demographics
NPI:1851668768
Name:KONTOS, THERESA WILKERSON (MSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:WILKERSON
Last Name:KONTOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:W
Other - Last Name:KONTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:8768 QUARTERS LAKE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2195
Mailing Address - Country:US
Mailing Address - Phone:225-937-4440
Mailing Address - Fax:
Practice Address - Street 1:8768 QUARTERS LAKE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2195
Practice Address - Country:US
Practice Address - Phone:225-937-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMFT580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist