Provider Demographics
NPI:1952532152
Name:SPIRITOSANTO, TERI (MFT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:SPIRITOSANTO
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 1:3429 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4935
Mailing Address - Country:US
Mailing Address - Phone:530-400-1766
Mailing Address - Fax:530-756-2811
Practice Address - Street 1:2056 LYNDELL TER
Practice Address - Street 2:SUITE 250B
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6208
Practice Address - Country:US
Practice Address - Phone:530-400-1766
Practice Address - Fax:530-756-2811
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist