Provider Demographics
NPI:1194376145
Name:TOWNE, TERRA LEE (PHD)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LEE
Last Name:TOWNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7693 PALMILLA DR APT 2421
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5088
Mailing Address - Country:US
Mailing Address - Phone:315-778-8028
Mailing Address - Fax:
Practice Address - Street 1:4510 EXECUTIVE DR STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3029
Practice Address - Country:US
Practice Address - Phone:858-534-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical