Provider Demographics
NPI:1164587804
Name:TERRY, DEBRA D (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:D
Last Name:TERRY
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 1:1745 ENTERPRISE DR
Mailing Address - Street 2:BLDG. 2 MS 2-270
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5801
Mailing Address - Country:US
Mailing Address - Phone:707-399-4900
Mailing Address - Fax:707-399-4957
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:BLDG. 2 MS 2-270
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-399-4900
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist