Provider Demographics
NPI:1497821078
Name:STUCKY, TERESA LARA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LARA
Last Name:STUCKY
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 1:143 SHELLEY CIR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5522
Mailing Address - Country:US
Mailing Address - Phone:805-205-5870
Mailing Address - Fax:
Practice Address - Street 1:4570 CALLE REAL
Practice Address - Street 2:CASA DEL MURAL
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1306
Practice Address - Country:US
Practice Address - Phone:805-692-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health