Provider Demographics
NPI:1669548806
Name:VO, THERESA KERN (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:KERN
Last Name:VO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KERN VO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:413 W BETHEL
Mailing Address - Street 2:#100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-680-4496
Mailing Address - Fax:972-304-0400
Practice Address - Street 1:413 W BETHEL
Practice Address - Street 2:#100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-680-4496
Practice Address - Fax:972-304-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist