Healthcare Provider Details

I. General information

NPI: 1316504772
Provider Name (Legal Business Name): THERESA MARIE SEARLES LPCC, 12851
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 HIGHWAY 4 STE A145
DISCOVERY BAY CA
94505
US

IV. Provider business mailing address

14850 HIGHWAY 4 STE A145
DISCOVERY BAY CA
94505-2282
US

V. Phone/Fax

Practice location:
  • Phone: 530-683-2085
  • Fax:
Mailing address:
  • Phone: 925-450-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: