Provider Demographics
NPI:1235973876
Name:DALY, TERESE ANN
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:ANN
Last Name:DALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752123
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77275-2123
Mailing Address - Country:US
Mailing Address - Phone:312-476-9064
Mailing Address - Fax:312-900-8230
Practice Address - Street 1:1448 N MILWAUKEE AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-6412
Practice Address - Country:US
Practice Address - Phone:312-476-9064
Practice Address - Fax:312-900-8230
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019906101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor