Provider Demographics
NPI:1952459182
Name:WILCOX, TERESSA LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:LEE
Last Name:WILCOX
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 1:18811 HUNTINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6002
Mailing Address - Country:US
Mailing Address - Phone:714-768-2400
Mailing Address - Fax:
Practice Address - Street 1:18811 HUNTINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6002
Practice Address - Country:US
Practice Address - Phone:714-768-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist