Provider Demographics
NPI:1780873273
Name:SIERRA, TERESA
Entity type:Individual
Prefix:MR
First Name:TERESA
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 E BETSY PL
Mailing Address - Street 2:3237 W. MONTANA ST
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8071
Mailing Address - Country:US
Mailing Address - Phone:520-721-7147
Mailing Address - Fax:520-721-9727
Practice Address - Street 1:9318 E BETSY PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8071
Practice Address - Country:US
Practice Address - Phone:520-721-7147
Practice Address - Fax:520-721-9727
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health