Provider Demographics
NPI:1104015882
Name:GELGOOD, TERI LYN (MFT)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:LYN
Last Name:GELGOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8103
Mailing Address - Country:US
Mailing Address - Phone:530-503-7040
Mailing Address - Fax:
Practice Address - Street 1:493 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95667-5321
Practice Address - Country:US
Practice Address - Phone:530-503-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist