Provider Demographics
NPI:1831604669
Name:ALEXANDER, THERESA SHEPPARD (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:THERESA SHEPPARD
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA, MFT
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 574
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORD
Mailing Address - State:CA
Mailing Address - Zip Code:94972
Mailing Address - Country:US
Mailing Address - Phone:707-874-9549
Mailing Address - Fax:
Practice Address - Street 1:3944 HARMONY VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:OCCIDENTAL
Practice Address - State:CA
Practice Address - Zip Code:95465
Practice Address - Country:US
Practice Address - Phone:707-874-9549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT8509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist