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NPI Code Detail

MEDICARE: MS. TETIA TEREZ HENSON LMFT

MEDICARE: MS. TETIA TEREZ HENSON 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 TherapistIMF 53334CA
2106H00000XMarriage & Family TherapistLMFT49722CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IMF 53334OTHERCABBS

General Provider Information

NPI Number : 1891965869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TETIA TEREZ HENSON LMFT
Provider Business Mailing Address
First Line : 12821 NEWPORT AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-2711
Country : US
Telephone Number : 562-264-5917
Fax Number : 714-333-4840
Provider Business Practice Location Address
First Line : 12821 NEWPORT AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-2711
Country : US
Telephone Number : 562-264-5917
Fax Number : 714-333-4840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2008
Last Update Date : 07/31/2020

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