Provider Demographics
NPI:1619003175
Name:TEOH, ALFREDA Y (MFT)
Entity Type:Individual
Prefix:
First Name:ALFREDA
Middle Name:Y
Last Name:TEOH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3312
Mailing Address - Country:US
Mailing Address - Phone:323-221-4134
Mailing Address - Fax:
Practice Address - Street 1:1721 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3312
Practice Address - Country:US
Practice Address - Phone:323-221-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF45744106H00000X
CA44949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist