Provider Demographics
NPI:1255703278
Name:HASENZAHL, TERRY (LMFT)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HASENZAHL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HASENZAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:711 OLD BALLAS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7051
Mailing Address - Country:US
Mailing Address - Phone:314-569-2253
Mailing Address - Fax:314-569-2280
Practice Address - Street 1:711 OLD BALLAS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7051
Practice Address - Country:US
Practice Address - Phone:314-569-2253
Practice Address - Fax:314-569-2280
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00504-L101YA0400X
MO2014001978106H00000X
NV0833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)