Provider Demographics
NPI:1063856854
Name:BARNETT-MARTIN, THERESE MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:BARNETT-MARTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:M
Other - Last Name:BARNETT-MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:9891 IRVINE CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4317
Mailing Address - Country:US
Mailing Address - Phone:949-709-2445
Mailing Address - Fax:
Practice Address - Street 1:9891 IRVINE CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4317
Practice Address - Country:US
Practice Address - Phone:949-709-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist