Provider Demographics
NPI:1992061139
Name:BENTLEY, TERESA CATHERINE (MA, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:CATHERINE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:CATHERINE
Other - Last Name:KOENINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LLPC
Mailing Address - Street 1:1360 W BUELL RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2326
Mailing Address - Country:US
Mailing Address - Phone:248-563-3401
Mailing Address - Fax:
Practice Address - Street 1:30472 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1844
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:586-627-0027
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional