Provider Demographics
NPI:1336284298
Name:TEOLA, JANE F (PSYD LCSW)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:F
Last Name:TEOLA
Suffix:
Gender:F
Credentials:PSYD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 BOUQUET CYN RD SUITE #201
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350
Mailing Address - Country:US
Mailing Address - Phone:661-645-1118
Mailing Address - Fax:888-456-2467
Practice Address - Street 1:28100 BOUQUET CYN RD SUITE #201
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350
Practice Address - Country:US
Practice Address - Phone:661-645-1118
Practice Address - Fax:888-456-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW6619104100000X, 1041C0700X
CA66191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker