Provider Demographics
NPI:1023495371
Name:JAY, TERESE (LSW)
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:JAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:
Other - Last Name:KOLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MSM-14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8871
Practice Address - Street 1:480 GALLETTI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5544
Practice Address - Country:US
Practice Address - Phone:775-982-8870
Practice Address - Fax:775-982-8871
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11019104100000X
NV11723-C1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator