Provider Demographics
NPI:1891965869
Name:HENSON, TETIA TEREZ (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TETIA
Middle Name:TEREZ
Last Name:HENSON
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 1:12821 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2711
Mailing Address - Country:US
Mailing Address - Phone:562-264-5917
Mailing Address - Fax:714-333-4840
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2711
Practice Address - Country:US
Practice Address - Phone:562-264-5917
Practice Address - Fax:714-333-4840
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 53334106H00000X
CALMFT49722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 53334OtherBBS