Provider Demographics
NPI:1194812149
Name:WALTON, TERESA ANN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:WALTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:TERI
Other - Middle Name:ANN
Other - Last Name:OHAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 ANDRE ST
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5017
Mailing Address - Country:US
Mailing Address - Phone:626-841-2266
Mailing Address - Fax:661-940-3795
Practice Address - Street 1:44738 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3225
Practice Address - Country:US
Practice Address - Phone:661-942-5749
Practice Address - Fax:661-940-3795
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC32930OtherMFT LICENSE