Provider Demographics
NPI:1871660266
Name:MIDDLETON, TERI MICHELE (MFT)
Entity Type:Individual
Prefix:MR
First Name:TERI
Middle Name:MICHELE
Last Name:MIDDLETON
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 1:6101 BALL ROAD
Mailing Address - Street 2:STE 306
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-236-9003
Mailing Address - Fax:714-236-9003
Practice Address - Street 1:6101 BALL ROAD
Practice Address - Street 2:STE 306
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:714-236-9003
Practice Address - Fax:714-236-9003
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist