MEDICARE: TERESA JENNETTE STERCK CACI, RP

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	101Y00000X	Counselor	NLC.0108358	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACA.0007666	CO

General Provider Information

NPI Number	:	1386201705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA JENNETTE STERCK CACI, RP

Provider Business Mailing Address
First Line	:	2565 AIRPORT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3119
Country	:	US
Telephone Number	:	719-632-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2565 AIRPORT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3119
Country	:	US
Telephone Number	:	719-632-3510
Fax Number	:

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

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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