Provider Demographics
NPI:1942360250
Name:RESH, TERESE ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:ELAINE
Last Name:RESH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:RESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:705 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2133
Mailing Address - Country:US
Mailing Address - Phone:530-926-5056
Mailing Address - Fax:
Practice Address - Street 1:705 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2133
Practice Address - Country:US
Practice Address - Phone:530-926-5056
Practice Address - Fax:530-926-5056
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 11137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LCS11137OtherSTATE LICENSE
CARHM53881FMedicaid
CARHM53881FMedicaid