| Doctor Name: | THERESA LONDON |
| NPI Number: | 1548683493 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CSW.09924302 |
| Business Practice Address: | 606 Main Street Limon, CO - 80828 |
| Business Phone Number: | 7197752313 |
| Business Fax Number: | 7197752315 |
| Mailing Address: | 211 W Main St, STERLING |
| State: | CO |
| Postal Code: | 807513168 |
| Phone Number: | 9705224549 |
| Fax Number: | 9705226898 |
| NPI Enumeration Date: | 01/29/2014 |
| NPI Last Update Date: | 03/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW.09924302 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |