Provider Demographics
NPI:1447307715
Name:GATES, THERESA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:GATES
Suffix:
Gender:F
Credentials:PHD
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 31776
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1776
Mailing Address - Country:US
Mailing Address - Phone:480-699-9431
Mailing Address - Fax:480-443-3600
Practice Address - Street 1:3027 N PLACITA FUENTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3429
Practice Address - Country:US
Practice Address - Phone:480-451-1684
Practice Address - Fax:480-443-3600
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1004103T00000X
CA15415103T00000X
AZ3397103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist