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NPI Code Detail

MEDICARE: DR. TERESA E LONEY PSY D

MEDICARE: DR. TERESA E LONEY PSY D
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
1103T00000XPsychologistR0393MO

General Provider Information

NPI Number : 1255364311
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA E LONEY PSY D
Provider Business Mailing Address
First Line : PO BOX 943
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-0943
Country : US
Telephone Number : 573-964-6010
Fax Number : 573-964-6909
Provider Business Practice Location Address
First Line : 1870 BAGNELL DAM BLVD
Second Line : SUITE B
City : LAKE OZARK
State : MO
Zip : 65049-8658
Country : US
Telephone Number : 573-964-6010
Fax Number : 573-964-6909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 07/08/2007

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Directions to “ DR. TERESA E LONEY PSY D” Practice Location

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