Provider Demographics
NPI:1104158575
Name:O'DONNELL, TERESA ANNE (LPC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANNE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 EMIL ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2311
Mailing Address - Country:US
Mailing Address - Phone:608-283-6426
Mailing Address - Fax:608-283-6374
Practice Address - Street 1:1409 EMIL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2311
Practice Address - Country:US
Practice Address - Phone:608-283-6426
Practice Address - Fax:608-283-6374
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4013-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health