Provider Demographics
NPI:1841372133
Name:ANSEL, TERI PHYLLIS (MFCC)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:PHYLLIS
Last Name:ANSEL
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:MS
Other - First Name:TOBY
Other - Middle Name:PHYLLIS
Other - Last Name:ANSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFCC
Mailing Address - Street 1:18403 UNIT E COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-708-8201
Mailing Address - Fax:
Practice Address - Street 1:18403 UNIT E COLLINS ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-708-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMS18169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18169OtherMFT