Provider Demographics
NPI:1235390865
Name:TINGEY, TERI K
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:K
Last Name:TINGEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 WOODLAKE MNR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2875
Mailing Address - Country:US
Mailing Address - Phone:805-523-2367
Mailing Address - Fax:
Practice Address - Street 1:2164 WINIFRED ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2934
Practice Address - Country:US
Practice Address - Phone:805-907-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health