Provider Demographics
NPI:1780635383
Name:LATHROP, TERESA ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:LATHROP
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 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3940
Mailing Address - Country:US
Mailing Address - Phone:808-955-0933
Mailing Address - Fax:808-955-0933
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-955-0933
Practice Address - Fax:808-955-0933
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist