Provider Demographics
NPI:1205959046
Name:TRUELOCK, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TRUELOCK
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 1:25 FIVE LKS
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-9707
Mailing Address - Country:US
Mailing Address - Phone:580-622-6810
Mailing Address - Fax:
Practice Address - Street 1:606 CIRCLE TOP DR.
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086
Practice Address - Country:US
Practice Address - Phone:580-993-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor