Provider Demographics
NPI:1972669141
Name:TEGAN, ARTEMIS (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ARTEMIS
Middle Name:
Last Name:TEGAN
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 1:1621 W 25TH ST # 221
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4301
Mailing Address - Country:US
Mailing Address - Phone:310-809-2011
Mailing Address - Fax:310-832-0862
Practice Address - Street 1:471 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3207
Practice Address - Country:US
Practice Address - Phone:310-809-2011
Practice Address - Fax:310-832-0862
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist