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NPI Code Detail

MEDICARE: TERESA LALICKER LMFT

MEDICARE: TERESA LALICKER LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist52140CA

General Provider Information

NPI Number : 1093125932
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA LALICKER LMFT
Provider Business Mailing Address
First Line : 5535 BALBOA BLVD STE 202
Second Line :
City : ENCINO
State : CA
Zip : 91316-1541
Country : US
Telephone Number : 818-577-0808
Fax Number :
Provider Business Practice Location Address
First Line : 5535 BALBOA BLVD STE 202
Second Line :
City : ENCINO
State : CA
Zip : 91316-1541
Country : US
Telephone Number : 818-577-0808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2014
Last Update Date : 04/13/2016

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Directions to “ TERESA LALICKER LMFT” Practice Location

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