Doctor Name: | MS. SARAH SUE TEASDALE |
NPI Number: | 1255407342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC LADAC MA |
License Number: | 3661 |
Business Practice Address: | 1362 C Trinity Dr Los Alamos, NM - 87544 |
Business Phone Number: | 5056623600 |
Business Fax Number: | 5056620937 |
Mailing Address: | 1362 C Trinity Dr, Corazon LOS ALAMOS |
State: | NM |
Postal Code: | 87544 |
Phone Number: | 5056623600 |
Fax Number: | 5056620937 |
NPI Enumeration Date: | 11/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 3661 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |