Provider Demographics
NPI:1518028950
Name:WILSHIN, TERESA SMITH (LMFT LICENSED MARRIA)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:SMITH
Last Name:WILSHIN
Suffix:
Gender:F
Credentials:LMFT LICENSED MARRIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25283 CABOT RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5509
Mailing Address - Country:US
Mailing Address - Phone:949-458-8145
Mailing Address - Fax:949-458-1586
Practice Address - Street 1:25283 CABOT RD
Practice Address - Street 2:SUITE #107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5509
Practice Address - Country:US
Practice Address - Phone:949-458-8145
Practice Address - Fax:949-458-1586
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33836106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist