Provider Demographics
NPI:1255941654
Name:BERNAL, TERESA (LMFT 121863)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:LMFT 121863
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4424
Mailing Address - Country:US
Mailing Address - Phone:831-728-6445
Mailing Address - Fax:
Practice Address - Street 1:4401 SEPULVEDA BLVD UNIT 210
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3934
Practice Address - Country:US
Practice Address - Phone:424-218-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11345101YP2500X
CA121863106H00000X
CA102051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional