1609007954 NPI number — MS. TERESE ANGELA WOLF M.S., LPC

Table of content: MS. TERESE ANGELA WOLF M.S., LPC (NPI 1609007954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609007954 NPI number — MS. TERESE ANGELA WOLF M.S., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
TERESE
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALZ
Provider Other First Name:
TERESE
Provider Other Middle Name:
ANGELA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609007954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80516-0302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-517-7396
Provider Business Mailing Address Fax Number:
300-500-7018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 ERIE VILLAGE SQ
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80516-6992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-517-7396
Provider Business Practice Location Address Fax Number:
303-500-7018
Provider Enumeration Date:
08/04/2009

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: 101YP2500X , with the licence number:  2514 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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