Provider Demographics
NPI:1245540517
Name:ALLEN, TEELA LARIE (LMFT, CMHIMP RYT-200)
Entity type:Individual
Prefix:
First Name:TEELA
Middle Name:LARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMFT, CMHIMP RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 REDONDO AVE # 539
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-8130
Mailing Address - Country:US
Mailing Address - Phone:402-612-7311
Mailing Address - Fax:
Practice Address - Street 1:115 W 4TH ST UNIT 212
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2312
Practice Address - Country:US
Practice Address - Phone:213-444-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT121261101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor