Healthcare Provider Details

I. General information

NPI: 1083244024
Provider Name (Legal Business Name): TERESA LYNNE HANNASCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BISHOP ST STE 200
SAN MARCOS TX
78666-2706
US

IV. Provider business mailing address

1321 E ZIPP RD
NEW BRAUNFELS TX
78130
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-7151
  • Fax:
Mailing address:
  • Phone: 830-515-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62298
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: