Provider Demographics
NPI:1942513270
Name:TORREALBA, THELMO III (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:THELMO
Middle Name:
Last Name:TORREALBA
Suffix:III
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N LARCH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1208
Mailing Address - Country:US
Mailing Address - Phone:517-643-3959
Mailing Address - Fax:517-484-5353
Practice Address - Street 1:430 N LARCH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1208
Practice Address - Country:US
Practice Address - Phone:517-643-3959
Practice Address - Fax:517-484-5353
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical