Provider Demographics
NPI:1003174335
Name:ISABELLA, TERI F (LPCMH)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:F
Last Name:ISABELLA
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 STORKWOOD RD APT A
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4182
Mailing Address - Country:US
Mailing Address - Phone:302-423-5596
Mailing Address - Fax:
Practice Address - Street 1:4777 STORKWOOD RD APT A
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4182
Practice Address - Country:US
Practice Address - Phone:302-423-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC-0000394OtherLICENSE