Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 01232 | MO |
Y | 103G00000X | Clinical Psychologist | 01232 | MO |
Y | 103TC0700X | Clinical Psychologist | 01232 | MO |
N | 103TH0004X | Health Psychologist | 01232 | MO |
NPI | 1124232699 |
---|---|
Provider Name | Teresa Leigh Deshields |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 10/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R00725 | (02) | MO |