Provider Demographics
NPI:1316460371
Name:TRIAS, TERESA ANNE FANTONE (LMFT)
Entity type:Individual
Prefix:
First Name:TERESA ANNE
Middle Name:FANTONE
Last Name:TRIAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 N 1ST ST STE 218
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5363
Mailing Address - Country:US
Mailing Address - Phone:408-418-6804
Mailing Address - Fax:
Practice Address - Street 1:586 N 1ST ST STE 218
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5363
Practice Address - Country:US
Practice Address - Phone:408-418-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist