1871660266 NPI number — MR. TERI MICHELE MIDDLETON MFT

Table of content: MR. TERI MICHELE MIDDLETON MFT (NPI 1871660266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871660266 NPI number — MR. TERI MICHELE MIDDLETON MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIDDLETON
Provider First Name:
TERI
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871660266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 BALL ROAD
Provider Second Line Business Mailing Address:
STE 306
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-236-9003
Provider Business Mailing Address Fax Number:
714-236-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 BALL ROAD
Provider Second Line Business Practice Location Address:
STE 306
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-236-9003
Provider Business Practice Location Address Fax Number:
714-236-9003
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC22357 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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