Provider Demographics
NPI:1619086519
Name:TERRY, MAE E (MFTI)
Entity Type:Individual
Prefix:MS
First Name:MAE
Middle Name:E
Last Name:TERRY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 COVERED WAGON CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3215
Mailing Address - Country:US
Mailing Address - Phone:916-363-4704
Mailing Address - Fax:
Practice Address - Street 1:7245 E SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2620
Practice Address - Country:US
Practice Address - Phone:916-427-7141
Practice Address - Fax:916-427-7122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist