Active NPI
Tetia Terez Henson, LMFT
- Marriage & Family Therapist
- Tustin, CA
National Provider Identifier
1891965869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT49722
- Practice address
- 12821 Newport Ave
Tustin, CA 92780-2711 - Phone
- (562) 264-5917
- Fax
- (714) 333-4840
- NPI assigned
- Mar 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | IMF 53334 | CA | |
| Marriage & Family Therapist | 106H00000X | LMFT49722 | CA | Primary |
Addresses
Primary practice location
12821 Newport Ave
Tustin, CA 92780-2711
Mailing address
12821 Newport Ave
Tustin, CA 92780-2711
Phone (562) 264-5917
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IMF 53334 | Other | CA | BBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF 53334 | CA | MD | Marriage & Family Therapist |
| LMFT49722 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596153600000",
"number": "1891965869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12821 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802711",
"telephone_number": "562-264-5917",
"fax_number": "714-333-4840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12821 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802711",
"telephone_number": "562-264-5917",
"fax_number": "714-333-4840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSON",
"first_name": "TETIA",
"middle_name": "TEREZ",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-06",
"last_updated": "2020-07-31",
"certification_date": "2020-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF 53334",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT49722",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BBS",
"identifier": "IMF 53334",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.