| Doctor Name: | TERESA MOUW |
| NPI Number: | 1033221270 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.C., L.P.C. |
| License Number: | LPC-10999 |
| Business Practice Address: | 1401 Nichols Ln Forest Grove, OR - 971163207 |
| Business Phone Number: | 5033592432 |
| Business Fax Number: | |
| Mailing Address: | Po Box 8459, PORTLAND |
| State: | OR |
| Postal Code: | 972078459 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 04/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-10999 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |