Provider Demographics
NPI:1124469457
Name:CLEMENT, TERESA L (LMHC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TERIE
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:1306 LAKE VIEW AVE
Mailing Address - Street 2:PO BOX 292
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1844
Mailing Address - Country:US
Mailing Address - Phone:360-568-8737
Mailing Address - Fax:360-568-1654
Practice Address - Street 1:1306 LAKE VIEW AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1844
Practice Address - Country:US
Practice Address - Phone:206-366-9384
Practice Address - Fax:360-568-1654
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60366966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health