Provider Demographics
NPI:1124162649
Name:PAULSEN, TERI SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:SUZANNE
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 W. VICTORIA ST.
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220
Mailing Address - Country:US
Mailing Address - Phone:562-477-3858
Mailing Address - Fax:
Practice Address - Street 1:1085 W. VICTORIA ST.
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220
Practice Address - Country:US
Practice Address - Phone:562-477-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical