Provider Demographics
NPI:1891494712
Name:UTLEY, TERESA IRENE (LMFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:IRENE
Last Name:UTLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14845 ROMULUS RD
Mailing Address - Street 2:
Mailing Address - City:COKER
Mailing Address - State:AL
Mailing Address - Zip Code:35452-3155
Mailing Address - Country:US
Mailing Address - Phone:205-242-6261
Mailing Address - Fax:
Practice Address - Street 1:2810 8TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2108
Practice Address - Country:US
Practice Address - Phone:205-242-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist