Provider Demographics
NPI:1538301775
Name:DUBOIS, THERESA LYNN (THERESA DUBOIS)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:THERESA DUBOIS
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERESA DUBOIS, MA
Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4780
Mailing Address - Country:US
Mailing Address - Phone:714-686-2524
Mailing Address - Fax:
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4780
Practice Address - Country:US
Practice Address - Phone:714-686-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist