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General NPI Number Information
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NPI Number | 1861222846
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Entity Type | Organization
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Legal Business Name | TERUCKO PLLC
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 242 S. 1ST AVE
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-580-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 14546 E 47TH LN
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City | YUMA
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State | AZ
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Zip | 85367-4962
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Country | US
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Telephone | 928-580-9711
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | TERUCKO COUCH
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Credential | MED. MA. LPC
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Telephone | 928-580-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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