Provider Demographics
NPI:1811238710
Name:COLLINS, TERESA (MFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:COLLINS
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 1:823 MICHELTORENA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2701
Mailing Address - Country:US
Mailing Address - Phone:323-791-9255
Mailing Address - Fax:
Practice Address - Street 1:823 MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2701
Practice Address - Country:US
Practice Address - Phone:323-791-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist