Provider Demographics
NPI:1033445002
Name:FERNANDEZ, TERESA ANN (MFT TRAINEE)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N VALENCIA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-1439
Mailing Address - Country:US
Mailing Address - Phone:559-564-5212
Mailing Address - Fax:
Practice Address - Street 1:168 N VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAKE
Practice Address - State:CA
Practice Address - Zip Code:93286-1439
Practice Address - Country:US
Practice Address - Phone:559-564-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health