Individual
DR. TERESA IONE COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
217 MARINE DR, BROOKINGS, OR 97415-8297
(541) 412-0700
(541) 412-0711
Mailing address
PO BOX 7666, BROOKINGS, OR 97415-0349
(541) 412-0700
(541) 412-0711
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2356
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500659667
—
OR
Enumeration date
06/28/2010
Last updated
09/20/2023
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