Provider Demographics
NPI:1598916231
Name:CONNELL, TERESA JAYNE (LPC, ATR-BC, NCC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JAYNE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LPC, ATR-BC, NCC
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:J
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, ATRBC, NCC
Mailing Address - Street 1:648 HUENERS LN UNIT F
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9023
Mailing Address - Country:US
Mailing Address - Phone:512-213-0575
Mailing Address - Fax:
Practice Address - Street 1:648 HUENERS LN UNIT F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9023
Practice Address - Country:US
Practice Address - Phone:512-459-3353
Practice Address - Fax:512-459-1658
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8877101YM0800X
101YM0800X
TX18917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional