Healthcare Provider Details

I. General information

NPI: 1043135346
Provider Name (Legal Business Name): THERESA BIEREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REESE WINTERS

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 MAIN ST
VENICE CA
90291-3783
US

IV. Provider business mailing address

1443 YALE ST APT 1
SANTA MONICA CA
90404-3131
US

V. Phone/Fax

Practice location:
  • Phone: 323-435-6047
  • Fax:
Mailing address:
  • Phone: 760-771-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: