Provider Demographics
NPI:1740069962
Name:MCMONIGAL, TERESA LYNNE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNNE
Last Name:MCMONIGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNNE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1056
Mailing Address - Country:US
Mailing Address - Phone:270-287-0656
Mailing Address - Fax:270-230-0328
Practice Address - Street 1:635 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1056
Practice Address - Country:US
Practice Address - Phone:270-287-0656
Practice Address - Fax:270-230-0328
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-23-278503106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician