Provider Demographics
NPI:1457755985
Name:EMBACH, TERESA (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:EMBACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:GEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:806 TUURI PL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2465
Mailing Address - Country:US
Mailing Address - Phone:810-767-5750
Mailing Address - Fax:810-237-7562
Practice Address - Street 1:806 TUURI PL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2465
Practice Address - Country:US
Practice Address - Phone:810-767-5750
Practice Address - Fax:810-237-7562
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional