Healthcare Provider Details

I. General information

NPI: 1457553414
Provider Name (Legal Business Name): MARIA-TERESA THOMAS MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 FRENCH ST
SANTA ANA CA
92701-2475
US

IV. Provider business mailing address

11312 CRESSON ST
NORWALK CA
90650-7628
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax:
Mailing address:
  • Phone: 562-868-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number50730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: