Individual
TERESA FAILLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1495 W 8TH STREET, FLORENCE, OR 97439-0007
(541) 997-6452
(541) 997-6452
Mailing address
PO BOX 183, FLORENCE, OR 97439
(541) 997-6452
(541) 997-6452
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
OR2025
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SC268890
—
OR
Enumeration date
11/09/2006
Last updated
10/01/2013
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