Healthcare Provider Details

I. General information

NPI: 1578629739
Provider Name (Legal Business Name): TERESA MARY ALLEN M.S., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 SANTA CLARA AVE.
OAKLAND CA
94610
US

IV. Provider business mailing address

286 SANTA CLARA AVE.
OAKLAND CA
94610
US

V. Phone/Fax

Practice location:
  • Phone: 510-788-6110
  • Fax: 510-201-2514
Mailing address:
  • Phone: 510-788-6110
  • Fax: 510-201-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC39878
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number39878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: