Provider Demographics
NPI:1548492960
Name:TEREBECKIJ, TINA LYNN
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:TEREBECKIJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNN
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:8984 DARROW RD STE 2-290
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2186
Mailing Address - Country:US
Mailing Address - Phone:855-437-6779
Mailing Address - Fax:330-840-7496
Practice Address - Street 1:24500 CENTER RIDGE RD STE 120
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5602
Practice Address - Country:US
Practice Address - Phone:440-899-1300
Practice Address - Fax:330-840-7496
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist