Provider Demographics
NPI:1598832974
Name:MARKES, TERESA CATHERINE (MA, LP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:CATHERINE
Last Name:MARKES
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:CATHERINE
Other - Last Name:GOLDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:149 THOMPSON AVE E STE 150
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3238
Practice Address - Country:US
Practice Address - Phone:651-450-0860
Practice Address - Fax:651-450-0759
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN112053100Medicaid
MN141965C154OtherUCARE
MN6260150OtherMEDICA CHOICE
MNHP16687OtherHEALTHPARTNERS
MN090D2MAOtherBCBS
MN411425197OtherCIGNA BEHAVIORAL HEALTH