Provider Demographics
NPI:1881879633
Name:WOOD, TERESA ELAINE (MHR)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ELAINE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:ELAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004
Mailing Address - Country:US
Mailing Address - Phone:918-720-5285
Mailing Address - Fax:
Practice Address - Street 1:1115 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:918-720-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health