Provider Demographics
NPI:1255407342
Name:TEASDALE, SARAH SUE (LPCC LADAC MA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:SUE
Last Name:TEASDALE
Suffix:
Gender:F
Credentials:LPCC LADAC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 C TRINITY DR
Mailing Address - Street 2:CORAZON
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-662-3600
Mailing Address - Fax:505-662-0937
Practice Address - Street 1:1362 C TRINITY DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544
Practice Address - Country:US
Practice Address - Phone:505-662-3600
Practice Address - Fax:505-662-0937
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3661101YA0400X
NM0472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional