Basic Information
| Provider Information | |||||||||
| NPI: | 1306018833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDY | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | LCSW, LIMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6541 SPECKER AVE | ||||||||
| Address2: | BUILDING 1830 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195037844 | ||||||||
| FaxNumber: | 7195037884 | ||||||||
| Practice Location | |||||||||
| Address1: | 6541 SPECKER AVE | ||||||||
| Address2: | BUILDING 1830 | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195037829 | ||||||||
| FaxNumber: | 7195037884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1025 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 1399 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1399 | 01 | NE | NEBRASKA DEPT OF HEALTH AND HUMAN SERVICES | OTHER | 1025 | 01 | NE | NEBRASKA DEPT OF HEALTH AND HUMAN SERVICES | OTHER |