Provider Demographics
NPI:1245999440
Name:MYERS, TERESA LAKE (LCDC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LAKE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2529
Mailing Address - Country:US
Mailing Address - Phone:432-264-4228
Mailing Address - Fax:432-268-9897
Practice Address - Street 1:1501 W 11TH PL STE 104
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4122
Practice Address - Country:US
Practice Address - Phone:432-263-0027
Practice Address - Fax:432-264-3298
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13334101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)