Provider Demographics
NPI:1053546143
Name:FRANCISCO, MARY TERESA
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:FRANCISCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:TERESA
Other - Last Name:VREEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16322 OLDENBURG CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8263
Mailing Address - Country:US
Mailing Address - Phone:317-896-9503
Mailing Address - Fax:
Practice Address - Street 1:615 N 18TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3434
Practice Address - Country:US
Practice Address - Phone:765-423-5361
Practice Address - Fax:765-742-8272
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)