Provider Demographics
NPI:1700807872
Name:MOLINA, TERESA STRUB (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:STRUB
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 NE 61ST ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5003
Mailing Address - Country:US
Mailing Address - Phone:816-531-2900
Mailing Address - Fax:816-531-2901
Practice Address - Street 1:3101 BROADWAY ST
Practice Address - Street 2:SUITE 230
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2659
Practice Address - Country:US
Practice Address - Phone:816-531-2900
Practice Address - Fax:816-531-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001029615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional