Provider Demographics
NPI:1568901130
Name:BRENNER-FARRELL, THERESA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:BRENNER-FARRELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2054
Mailing Address - Country:US
Mailing Address - Phone:805-216-2369
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 250
Practice Address - Street 2:VENTURA
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3571
Practice Address - Country:US
Practice Address - Phone:805-216-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111434106H00000X
CAIMF83550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health