Provider Demographics
NPI:1245901230
Name:LAND, TERESA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 E US HIGHWAY 36 STE A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8174
Mailing Address - Country:US
Mailing Address - Phone:317-790-9396
Mailing Address - Fax:
Practice Address - Street 1:10080 E US HIGHWAY 36 STE A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8174
Practice Address - Country:US
Practice Address - Phone:317-790-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006472A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical