Healthcare Provider Details

I. General information

NPI: 1104522721
Provider Name (Legal Business Name): TEO ESTEPANI ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N BRAND BLVD SUITE 200 UNIT #284
GLENDALE CA
91203-1886
US

IV. Provider business mailing address

14 S CHURCH ST APT 1
WEST CHESTER PA
19382-3248
US

V. Phone/Fax

Practice location:
  • Phone: 713-828-3806
  • Fax:
Mailing address:
  • Phone: 323-347-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84722
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20534
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20534
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC015754
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: