Provider Demographics
NPI:1194315549
Name:WILSON, TERESA ANN COMBS (MA LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN COMBS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RIGSBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-3054
Mailing Address - Country:US
Mailing Address - Phone:865-243-6896
Mailing Address - Fax:
Practice Address - Street 1:18670 FORTY SIX PKWY
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6888
Practice Address - Country:US
Practice Address - Phone:830-481-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional