Provider Demographics
NPI:1386281335
Name:CLOYD, THERESA (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CLOYD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:RIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3745 E DEWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1806
Mailing Address - Country:US
Mailing Address - Phone:480-694-7955
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 2020
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6213
Practice Address - Country:US
Practice Address - Phone:480-442-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty