Provider Demographics
NPI:1235385188
Name:BRODIE, TERRY (MFT 46116)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BRODIE
Suffix:
Gender:F
Credentials:MFT 46116
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BOULDER ST,
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:530-277-0316
Mailing Address - Fax:530-272-8564
Practice Address - Street 1:206 SACRAMENTO ST.
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959
Practice Address - Country:US
Practice Address - Phone:503-277-0316
Practice Address - Fax:530-272-8564
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist