Provider Demographics
NPI:1235564501
Name:TERRY, GITA (MA, MFT, JD)
Entity Type:Individual
Prefix:MS
First Name:GITA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:MA, MFT, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANADA ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7866
Mailing Address - Country:US
Mailing Address - Phone:805-987-3162
Mailing Address - Fax:805-303-1502
Practice Address - Street 1:155 GRANADA ST
Practice Address - Street 2:SUITE N
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7866
Practice Address - Country:US
Practice Address - Phone:805-987-3162
Practice Address - Fax:805-303-1502
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist