Provider Demographics
NPI:1083163653
Name:SOOHOO, TERRY (PHD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:SOOHOO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:SOO-HOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:40844 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3800
Mailing Address - Country:US
Mailing Address - Phone:510-668-0628
Mailing Address - Fax:
Practice Address - Street 1:40844 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3800
Practice Address - Country:US
Practice Address - Phone:510-885-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11558103TC0700X
CALMFT19783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist