Healthcare Provider Details

I. General information

NPI: 1508292491
Provider Name (Legal Business Name): TERESA GELDMACHER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 12/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30131 TOWN CENTER DR #292
LAGUNA NIGUEL CA
92677-2034
US

IV. Provider business mailing address

24812 HON AVE
LAGUNA HILLS CA
92653-4316
US

V. Phone/Fax

Practice location:
  • Phone: 949-302-4390
  • Fax:
Mailing address:
  • Phone: 949-302-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT50543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: