Provider Demographics
NPI:1376826594
Name:NELSON-TERRY, GWENDOLYN ERIN (LMFT)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ERIN
Last Name:NELSON-TERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 S EL CAMINO REAL UNIT D206
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4975
Mailing Address - Country:US
Mailing Address - Phone:415-678-0186
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2657
Practice Address - Country:US
Practice Address - Phone:619-383-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist