Provider Demographics
NPI:1336885979
Name:TEEFY, MAUREEN J (AMFT, APCC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:J
Last Name:TEEFY
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90294-1194
Mailing Address - Country:US
Mailing Address - Phone:310-612-3193
Mailing Address - Fax:
Practice Address - Street 1:653 CRESTMOORE PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4814
Practice Address - Country:US
Practice Address - Phone:310-612-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT130788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist