Provider Demographics
NPI:1194885954
Name:WOLFE, TERISA LORRIANE (MFTI)
Entity type:Individual
Prefix:
First Name:TERISA
Middle Name:LORRIANE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:TERISA
Other - Middle Name:LORRIANE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14112 TEMPLE CIR
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-9413
Mailing Address - Country:US
Mailing Address - Phone:530-876-1913
Mailing Address - Fax:
Practice Address - Street 1:14112 TEMPLE CIR
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9413
Practice Address - Country:US
Practice Address - Phone:530-876-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF50887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist