Individual
THERESA DE LA FUENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 E JEFFERSON AVE STE 202B, NAPERVILLE, IL 60540-8405
(347) 921-2175
Mailing address
43 E JEFFERSON AVE STE 202B, NAPERVILLE, IL 60540-8405
(415) 574-7176
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
166.001309
IL
106H00000X
Marriage & Family Therapist
77981
CA
Other
Enumeration date
08/06/2012
Last updated
12/19/2022
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