Provider Demographics
NPI:1295029106
Name:HIMES, TERESE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESE
Middle Name:M
Last Name:HIMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST
Mailing Address - Street 2:#115A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7514
Mailing Address - Country:US
Mailing Address - Phone:559-906-0637
Mailing Address - Fax:
Practice Address - Street 1:5100 N 6TH ST
Practice Address - Street 2:#115A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7514
Practice Address - Country:US
Practice Address - Phone:559-906-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical