Provider Demographics
NPI:1972698231
Name:HAVILAND, THERESE (LMFT)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:
Last Name:HAVILAND
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 1:1108 OPAL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3923
Mailing Address - Country:US
Mailing Address - Phone:310-316-1610
Mailing Address - Fax:310-316-1610
Practice Address - Street 1:1108 OPAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3923
Practice Address - Country:US
Practice Address - Phone:310-316-1610
Practice Address - Fax:310-316-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist