Provider Demographics
NPI:1730598202
Name:TEASLEY, REBECCA (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HIGHWAY 1216
Mailing Address - Street 2:
Mailing Address - City:ZWOLLE
Mailing Address - State:LA
Mailing Address - Zip Code:71486
Mailing Address - Country:US
Mailing Address - Phone:318-332-1063
Mailing Address - Fax:
Practice Address - Street 1:3800 HIGHWAY 1216
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-3081
Practice Address - Country:US
Practice Address - Phone:318-332-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5441101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool