Individual
JACK A TEITSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1616 PONTE LEONE LN, LEAGUE CITY, TX 77573-5067
(630) 386-5106
Mailing address
1616 PONTE LEONE LN, LEAGUE CITY, TX 77573-5067
(630) 386-5106
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
34453
TX
Other
Enumeration date
06/25/2009
Last updated
12/11/2011
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