Provider Demographics
NPI:1316421613
Name:JETHANI, THERESA O'BRIEN (RBT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:O'BRIEN
Last Name:JETHANI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 SANTA CRUZ RDG
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-9048
Mailing Address - Country:US
Mailing Address - Phone:605-519-4000
Mailing Address - Fax:
Practice Address - Street 1:172 SANTA CRUZ RDG
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95033-9048
Practice Address - Country:US
Practice Address - Phone:605-519-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician