Provider Demographics
NPI:1699817296
Name:HARTT, TERI (MA,MFT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:HARTT
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1688
Mailing Address - Country:US
Mailing Address - Phone:818-407-6945
Mailing Address - Fax:818-879-9167
Practice Address - Street 1:5923 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:818-407-6945
Practice Address - Fax:818-879-9167
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health