Provider Demographics
NPI:1053129718
Name:SPELLMAN, THERESE E (LMFT)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:E
Last Name:SPELLMAN
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 1:4049 MADISON AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3247
Mailing Address - Country:US
Mailing Address - Phone:626-314-4261
Mailing Address - Fax:
Practice Address - Street 1:130 S EUCLID AVE STE 8
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2472
Practice Address - Country:US
Practice Address - Phone:626-314-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127099106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist