Provider Demographics
NPI:1396493532
Name:TERI'S HEALTH SERVICES
Entity type:Organization
Organization Name:TERI'S HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-318-3835
Mailing Address - Street 1:6635 W HAPPY VALLEY RD STE A104-621
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2609
Mailing Address - Country:US
Mailing Address - Phone:602-358-7073
Mailing Address - Fax:888-927-0409
Practice Address - Street 1:40 N SWAN RD STE 118
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3019
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERI HOURIHAN COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-16
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ087398Medicaid
AZ405477Medicaid