Provider Demographics
NPI:1841552296
Name:AMBLE, TERESE MARIE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:TERESE
Middle Name:MARIE
Last Name:AMBLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:MARIE
Other - Last Name:PERREAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 SMITH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2346
Mailing Address - Country:US
Mailing Address - Phone:651-220-6720
Mailing Address - Fax:651-220-6707
Practice Address - Street 1:345 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2346
Practice Address - Country:US
Practice Address - Phone:651-220-6720
Practice Address - Fax:651-220-6707
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5816103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program