Provider Demographics
NPI:1871146399
Name:JOHN, TERI ANN (RADT-I)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:ANN
Last Name:JOHN
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4322
Mailing Address - Country:US
Mailing Address - Phone:661-327-9376
Mailing Address - Fax:661-327-7648
Practice Address - Street 1:1124 BAKER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4322
Practice Address - Country:US
Practice Address - Phone:661-327-9376
Practice Address - Fax:661-327-7648
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)