| Doctor Name: | TERESE MISENCIK |
| NPI Number: | 1023481306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA,LICDC |
| License Number: | 081201 |
| Business Practice Address: | 8701 Mentor Ave Mentor, OH - 440606103 |
| Business Phone Number: | 4402660770 |
| Business Fax Number: | 4402660257 |
| Mailing Address: | 8701 Mentor Ave, MENTOR |
| State: | OH |
| Postal Code: | 440606103 |
| Phone Number: | 4402660770 |
| Fax Number: | 4402660257 |
| NPI Enumeration Date: | 11/09/2015 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 081201 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |