Provider Demographics
NPI:1538593546
Name:HEALD, TERESA ANNE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANNE
Last Name:HEALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 E QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-5059
Mailing Address - Country:US
Mailing Address - Phone:208-365-5445
Mailing Address - Fax:
Practice Address - Street 1:4700 N CLOVERDALE RD STE 208
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1068
Practice Address - Country:US
Practice Address - Phone:208-283-2527
Practice Address - Fax:208-550-3478
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33002104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker