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General NPI Number Information
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NPI Number | 1639904410
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Entity Type | Individual
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Provider Name | TERESA JOLINE TROUT LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 445 BELLEVUE AVE STE 104C
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City | OAKLAND
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State | CA
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Zip | 94610-4923
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Country | US
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Telephone | 510-294-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 7288 S RACQUET CLUB DR
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-4521
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Country | US
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Telephone | 510-294-2965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 137191
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License Number State | CA
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