Provider Demographics
NPI:1265535843
Name:ALLEN-LAVENAU, THERESA MARY (MFT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARY
Last Name:ALLEN-LAVENAU
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 1:18700 BEACH BLVD
Mailing Address - Street 2:#230
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-965-9204
Mailing Address - Fax:714-965-9207
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:#230
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-965-9204
Practice Address - Fax:714-965-9207
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist