Provider Demographics
NPI:1376702415
Name:WEYL, TERRY CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:CHARLES
Last Name:WEYL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 SPRING ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4546
Mailing Address - Country:US
Mailing Address - Phone:530-341-8772
Mailing Address - Fax:530-698-5241
Practice Address - Street 1:941 SPRING ST STE 5
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4546
Practice Address - Country:US
Practice Address - Phone:530-341-8772
Practice Address - Fax:530-698-5241
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY061380Medicaid