Provider Demographics
NPI:1235203720
Name:ORGANO, THERESA MARY (M A , IMFT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARY
Last Name:ORGANO
Suffix:
Gender:F
Credentials:M A , IMFT
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:MARY
Other - Last Name:HODGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:446 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3249
Mailing Address - Country:US
Mailing Address - Phone:805-937-3783
Mailing Address - Fax:
Practice Address - Street 1:500 W FOSTER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3620
Practice Address - Country:US
Practice Address - Phone:805-934-6385
Practice Address - Fax:805-934-6539
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINTERN 47364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47364OtherMFT INTERN
CA47364OtherMFT INTERN