Provider Demographics
NPI:1811322530
Name:GOSCICKI, TERESA M (MA, LLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:GOSCICKI
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:STEENLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:41100 PLYMOUTH RD STE B1-215
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3799
Mailing Address - Country:US
Mailing Address - Phone:248-954-4837
Mailing Address - Fax:
Practice Address - Street 1:39325 PLYMOUTH RD STE 201
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4531
Practice Address - Country:US
Practice Address - Phone:248-954-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015944103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist