Provider Demographics
NPI:1972929784
Name:BEAR, TERESA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:BEAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 REGENT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1263
Mailing Address - Country:US
Mailing Address - Phone:608-709-0018
Mailing Address - Fax:
Practice Address - Street 1:1050 REGENT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1263
Practice Address - Country:US
Practice Address - Phone:608-709-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2663-57103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling