Basic Information
| Provider Information | |||||||||
| NPI: | 1205043965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLE | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E SYCAMORE AVE | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902453262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106402356 | ||||||||
| FaxNumber: | 3106475657 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 S. MRYTLE AVE. | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263573258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC40030 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.