1235363169 NPI number — MRS. MARIA TERESA ALVARADO LCPC

Table of content: MRS. MARIA TERESA ALVARADO LCPC (NPI 1235363169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235363169 NPI number — MRS. MARIA TERESA ALVARADO LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVARADO
Provider First Name:
MARIA
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
MARIA
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235363169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 STAMPEDE DR STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83687-6879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-821-7829
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 STAMPEDE DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687-6879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-821-7829
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LCPC4191 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LCPC 4191 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".