MEDICARE: MS. TERESA SMITH WILSHIN LMFT LICENSED MARRIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT33836	CA

General Provider Information

NPI Number	:	1518028950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA SMITH WILSHIN LMFT LICENSED MARRIA

Provider Business Mailing Address
First Line	:	25283 CABOT RD
Second Line	:	SUITE #107
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5509
Country	:	US
Telephone Number	:	949-458-8145
Fax Number	:	949-458-1586

Provider Business Practice Location Address
First Line	:	25283 CABOT RD
Second Line	:	SUITE #107
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5509
Country	:	US
Telephone Number	:	949-458-8145
Fax Number	:	949-458-1586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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