Provider Demographics
NPI:1538611868
Name:BRISCOE, TERESA (MS LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SW 34TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7105 SW 34TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3961
Practice Address - Country:US
Practice Address - Phone:806-681-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional