Provider Demographics
NPI:1437553344
Name:GATEWOOD, TERRY LANE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LANE
Last Name:GATEWOOD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 SEARCHLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-6827
Mailing Address - Country:US
Mailing Address - Phone:323-217-8600
Mailing Address - Fax:760-406-4045
Practice Address - Street 1:2962 SEARCHLIGHT LN
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-6827
Practice Address - Country:US
Practice Address - Phone:323-217-8600
Practice Address - Fax:760-406-4045
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical