Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 38823 | TX |
NPI | 1003144163 |
---|---|
Provider Name | Teresa Kay Oldham |
First Address | Jarrell, TX 76537-1438 |
Second Address | Belton, TX 76513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 05/11/2020 |