Provider Demographics
NPI:1083621932
Name:SMITH, TERRY ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 LINDBROOK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3042
Mailing Address - Country:US
Mailing Address - Phone:310-824-2076
Mailing Address - Fax:323-653-1211
Practice Address - Street 1:10845 LINDBROOK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3042
Practice Address - Country:US
Practice Address - Phone:310-824-2076
Practice Address - Fax:323-653-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8919Medicare ID - Type Unspecified