Provider Demographics
NPI:1295372241
Name:ARREDONDO, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ARREDONDO
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 1:11277 GARDEN GROVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1300
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:714-620-8132
Practice Address - Street 1:11277 GARDEN GROVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1300
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:714-620-8132
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health