Provider Demographics
NPI:1376562983
Name:MEYERS, TERRY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:E
Last Name:MEYERS
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 1:4024 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1761
Mailing Address - Country:US
Mailing Address - Phone:510-482-2771
Mailing Address - Fax:
Practice Address - Street 1:4026 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1761
Practice Address - Country:US
Practice Address - Phone:510-482-2771
Practice Address - Fax:928-395-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA431997629OtherEIN
CA431997629OtherEIN