MEDICARE: TERESA J MARSHALL PH.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
1	103T00000X	Psychologist	PSY.0001394	CO
2	103TB0200X	Cognitive & Behavioral Psychologist	1394	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588627202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA J MARSHALL PH.D.

Provider Business Mailing Address
First Line	:	2860 S CIRCLE DR
Second Line	:	STE 250L
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4132
Country	:	US
Telephone Number	:	719-406-1223
Fax Number	:	719-465-1394

Provider Business Practice Location Address
First Line	:	2860 S. CIRCLE DR
Second Line	:	STE 250L
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4132
Country	:	US
Telephone Number	:	719-406-1223
Fax Number	:	719-465-1394

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	03/21/2022

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