Provider Demographics
NPI:1750324323
Name:BUDNER, TERI WRIGHT (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:WRIGHT
Last Name:BUDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERI
Other - Middle Name:MARIE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2101 N MAIN ST
Mailing Address - Street 2:STE. D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2701
Mailing Address - Country:US
Mailing Address - Phone:714-558-8487
Mailing Address - Fax:714-558-8497
Practice Address - Street 1:2101 N MAIN ST
Practice Address - Street 2:STE. D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2701
Practice Address - Country:US
Practice Address - Phone:714-558-8487
Practice Address - Fax:714-558-8497
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA74319OtherMHN
CA74319OtherMHN