Provider Demographics
NPI:1396075305
Name:HOWARD, THERESA E (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:E
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:THRESA
Other - Middle Name:
Other - Last Name:BELANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3636 VILLA PARK DRIVE
Mailing Address - Street 2:BASEMENT LEVEL
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249
Mailing Address - Country:US
Mailing Address - Phone:618-654-8914
Mailing Address - Fax:618-654-8782
Practice Address - Street 1:3636 VILLA PARK DRIVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249
Practice Address - Country:US
Practice Address - Phone:618-654-8914
Practice Address - Fax:618-654-8782
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor