Healthcare Provider Details

I. General information

NPI: 1306018833
Provider Name (Legal Business Name): TERESA I. JUDY LCSW, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

6541 SPECKER AVE BUILDING 1830
COLORADO SPRINGS CO
80913-4263
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-7844
  • Fax: 719-503-7884
Mailing address:
  • Phone: 719-503-7844
  • Fax: 719-503-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1399
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1025
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: