Provider Demographics
NPI:1689182339
Name:TESCHERA, JEREMY (MA)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:TESCHERA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 EMERSON CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3845
Mailing Address - Country:US
Mailing Address - Phone:408-318-8854
Mailing Address - Fax:
Practice Address - Street 1:3919 W HAZARD AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2625
Practice Address - Country:US
Practice Address - Phone:562-335-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist