Provider Demographics
NPI:1265532790
Name:BACH, TERI (MFT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:BACH
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 1:100 N WINCHESTER BLVD
Mailing Address - Street 2:SUITE 264
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6520
Mailing Address - Country:US
Mailing Address - Phone:925-890-3366
Mailing Address - Fax:925-829-6665
Practice Address - Street 1:100 N WINCHESTER BLVD
Practice Address - Street 2:SUITE 264
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6520
Practice Address - Country:US
Practice Address - Phone:925-890-3366
Practice Address - Fax:925-829-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health