Provider Demographics
NPI:1891925293
Name:ANDERSON, TERESA M (LMHC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 CENTRAL AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-955-1836
Mailing Address - Fax:515-955-7115
Practice Address - Street 1:1728 CENTRAL AVE STE 14
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-955-1836
Practice Address - Fax:515-955-7115
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07061101YA0400X
101YM0800X
IA001287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
IA07466OtherWELLMARK BC/BS