1164690186 NPI number — TERESA J MARSHALL PSYCHOLOGIAL SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164690186 NPI number — TERESA J MARSHALL PSYCHOLOGIAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERESA J MARSHALL PSYCHOLOGIAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164690186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2860 S CIRCLE DR.
Provider Second Line Business Mailing Address:
STE 250L
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80906-4132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-406-1223
Provider Business Mailing Address Fax Number:
719-465-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2860 S CIRCLE DR
Provider Second Line Business Practice Location Address:
STE 250L
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-406-1223
Provider Business Practice Location Address Fax Number:
719-465-1394
Provider Enumeration Date:
02/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
719-406-1223

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1394 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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