Provider Demographics
NPI:1841434594
Name:CAREY, THERESA M (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:CAREY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S UNION ST STE 212
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2551
Mailing Address - Country:US
Mailing Address - Phone:231-932-0911
Mailing Address - Fax:231-932-1011
Practice Address - Street 1:104 S UNION ST STE 212
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2551
Practice Address - Country:US
Practice Address - Phone:231-932-0911
Practice Address - Fax:231-932-1011
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008416101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor