Provider Demographics
NPI:1215340526
Name:SCOTT, TERESA DILLON (MFTINTERN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DILLON
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MFTINTERN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1641 BELLEVILLE WAY APT O
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3930
Mailing Address - Country:US
Mailing Address - Phone:415-370-6760
Mailing Address - Fax:
Practice Address - Street 1:1641 BELLEVILLE WAY APT O
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3930
Practice Address - Country:US
Practice Address - Phone:415-370-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist