MEDICARE: THERESA GOMES LMFTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	4621	SC

General Provider Information

NPI Number	:	1154445682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA GOMES LMFTS

Provider Business Mailing Address
First Line	:	201 CARPENTER DR
Second Line	:
City	:	LANDRUM
State	:	SC
Zip	:	29356-9435
Country	:	US
Telephone Number	:	864-663-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 S PINE ST STE A205
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2654
Country	:	US
Telephone Number	:	864-663-2218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/24/2024

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