Healthcare Provider Details

I. General information

NPI: 1598732364
Provider Name (Legal Business Name): THERESA ANN LAWSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CENTRAL AVE LIFE SKILLS SUPPORT CENTER
EIELSON AFB AK
99702-2325
US

IV. Provider business mailing address

2414 SUNDOG CT APT B
EIELSON AFB AK
99702-3102
US

V. Phone/Fax

Practice location:
  • Phone: 907-377-3071
  • Fax: 907-377-3690
Mailing address:
  • Phone: 907-373-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1022
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: