Provider Demographics
NPI:1184978660
Name:SMITH, TERESA SUE (LPCC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3167
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-6167
Mailing Address - Country:US
Mailing Address - Phone:575-621-6365
Mailing Address - Fax:
Practice Address - Street 1:7264 NORMANDY DR
Practice Address - Street 2:FT. RILEY
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66442-4461
Practice Address - Country:US
Practice Address - Phone:573-239-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0963101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor