Provider Demographics
NPI:1972967941
Name:BERREZUETA-LUCE, TERESITA (LPC)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:BERREZUETA-LUCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2546
Mailing Address - Country:US
Mailing Address - Phone:214-770-5762
Mailing Address - Fax:
Practice Address - Street 1:628 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6328
Practice Address - Country:US
Practice Address - Phone:214-941-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional