Provider Demographics
NPI:1366408437
Name:FELDHAUSEN, THERESA DOLLE (MS)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DOLLE
Last Name:FELDHAUSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:DOLLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:406 LILLY RD NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5118
Mailing Address - Country:US
Mailing Address - Phone:360-456-5892
Mailing Address - Fax:
Practice Address - Street 1:406 LILLY RD NE
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5118
Practice Address - Country:US
Practice Address - Phone:360-456-5546
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004137101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor