Provider Demographics
NPI:1174606560
Name:KEY, TERESA L (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:KEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERI
Other - Middle Name:L
Other - Last Name:KEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1907 COUNTRY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1930
Mailing Address - Country:US
Mailing Address - Phone:760-439-5061
Mailing Address - Fax:858-755-9010
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:STE. 427
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-638-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17537Medicare PIN