Teresa Faillace, LCSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

OR2025 Issued in OR

Practice address

1495 W 8TH Street
Florence, OR 97439-0007

Phone

(541) 997-6452

Fax

(541) 997-6452

NPI assigned

Nov 9, 2006

Last updated

Oct 1, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380585600000",
    "number": "1548330145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 183",
            "city": "FLORENCE",
            "state": "OR",
            "postal_code": "97439",
            "telephone_number": "541-997-6452",
            "fax_number": "541-997-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 W 8TH STREET",
            "city": "FLORENCE",
            "state": "OR",
            "postal_code": "974390007",
            "telephone_number": "541-997-6452",
            "fax_number": "541-997-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAILLACE",
        "first_name": "TERESA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "OR2025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SC268890",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda M Elliott, CRNA
• Emerald Sleep Disorders Center, LLC (Florence Sleep Disorders Center)
• Kimberly England, CMHC
• Beth E. Erickson, LCSW
• Kathy A Evans
• Alec Fedorov, M.D.
• Florence Chiropractic Clinic, P.C.
• Florence Dental Clinic
• Florence Medical Inc (Florence Medical Equipment)
• Sara Covey Flores

• Psychologist in Florence, OR
• Providers in Florence, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.