Healthcare Provider Details

I. General information

NPI: 1942416847
Provider Name (Legal Business Name): THERESA MARIE SEWARD MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 W BELL RD SUITE A102
SURPRISE AZ
85378-9705
US

IV. Provider business mailing address

12301 W BELL RD SUITE A102
SURPRISE AZ
85378-9705
US

V. Phone/Fax

Practice location:
  • Phone: 623-330-1099
  • Fax: 623-583-3888
Mailing address:
  • Phone: 623-330-1099
  • Fax: 623-583-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10623
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: