Provider Demographics
NPI:1306120324
Name:KLINE, TERESA (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:KLINE
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:PO BOX 2594
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75123-2594
Mailing Address - Country:US
Mailing Address - Phone:866-619-4954
Mailing Address - Fax:
Practice Address - Street 1:201 AMANDA LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1390
Practice Address - Country:US
Practice Address - Phone:866-619-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional