Healthcare Provider Details

I. General information

NPI: 1194885954
Provider Name (Legal Business Name): TERISA LORRIANE WOLFE MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERISA LORRIANE BREWER

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14112 TEMPLE CIR
MAGALIA CA
95954-9413
US

IV. Provider business mailing address

14112 TEMPLE CIR
MAGALIA CA
95954-9413
US

V. Phone/Fax

Practice location:
  • Phone: 530-876-1913
  • Fax:
Mailing address:
  • Phone: 530-876-1913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF50887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: