Provider Demographics
NPI:1356019780
Name:VILLASENOR, TERESA LYNN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:LYNN
Other - Last Name:VILLASENOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2709
Mailing Address - Country:US
Mailing Address - Phone:650-793-3908
Mailing Address - Fax:
Practice Address - Street 1:3650 AUBURN BLVD # C208
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2069
Practice Address - Country:US
Practice Address - Phone:916-701-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health