Provider Demographics
NPI:1851586242
Name:JAQUEZ, TERESA (LMFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N IRWIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4579
Mailing Address - Country:US
Mailing Address - Phone:559-584-1774
Mailing Address - Fax:559-584-1771
Practice Address - Street 1:101 N IRWIN ST STE 210
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4579
Practice Address - Country:US
Practice Address - Phone:559-584-1774
Practice Address - Fax:559-584-1771
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health