Provider Demographics
NPI:1518225226
Name:ANDERSON, TERRENCE (TERRY) H (MS,PSYD,LMFT)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE (TERRY)
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS,PSYD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18452 DURFEE CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4520
Mailing Address - Country:US
Mailing Address - Phone:714-997-9262
Mailing Address - Fax:
Practice Address - Street 1:228 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4320
Practice Address - Country:US
Practice Address - Phone:714-457-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist