Provider Demographics
NPI:1699348532
Name:TERESA, GABRIELA R (LMFT)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:R
Last Name:TERESA
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 1:819 N SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2530
Mailing Address - Country:US
Mailing Address - Phone:626-484-6514
Mailing Address - Fax:
Practice Address - Street 1:819 N SAN GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2530
Practice Address - Country:US
Practice Address - Phone:626-484-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist