Healthcare Provider Details

I. General information

NPI: 1104749761
Provider Name (Legal Business Name): MRS. TERESA CAMILLE LEHMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4821 MERLOT AVE UNIT 210
GRAPEVINE TX
76051-7386
US

IV. Provider business mailing address

138 HEATHER RIDGE CT
WEATHERFORD TX
76085-8122
US

V. Phone/Fax

Practice location:
  • Phone: 682-439-6669
  • Fax:
Mailing address:
  • Phone: 817-521-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberOTHER
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: