Provider Demographics
NPI:1104522721
Name:ESTEPANI, TEO (MED)
Entity type:Individual
Prefix:
First Name:TEO
Middle Name:
Last Name:ESTEPANI
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 NORTH LOOP W STE 940
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-5602
Mailing Address - Country:US
Mailing Address - Phone:832-979-9302
Mailing Address - Fax:
Practice Address - Street 1:1415 NORTH LOOP W STE 940
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-5602
Practice Address - Country:US
Practice Address - Phone:832-940-2352
Practice Address - Fax:713-338-2371
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional