Provider Demographics
NPI:1174774475
Name:TEASLEY, GINGER LEIGH (MA, LMFT)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:LEIGH
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42025 N CLUB POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1966
Mailing Address - Country:US
Mailing Address - Phone:623-551-9161
Mailing Address - Fax:
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:BUILDNG D, STE 102-106, UNIT 3
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:623-853-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist