Provider Demographics
NPI:1548698228
Name:HOMER, TERESA (LPCC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 SILVER AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3123
Mailing Address - Country:US
Mailing Address - Phone:505-470-0661
Mailing Address - Fax:505-843-9520
Practice Address - Street 1:5824 NIGHT ROSE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3591
Practice Address - Country:US
Practice Address - Phone:505-470-0661
Practice Address - Fax:505-843-9520
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0154271101YM0800X
NM0178731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health