Provider Demographics
NPI:1851325468
Name:TERRY, GISELE (MFT)
Entity Type:Individual
Prefix:MS
First Name:GISELE
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3104
Mailing Address - Country:US
Mailing Address - Phone:310-473-1885
Mailing Address - Fax:323-658-7523
Practice Address - Street 1:1531 PURDUE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3104
Practice Address - Country:US
Practice Address - Phone:310-473-1885
Practice Address - Fax:323-658-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29833OtherMFT LICENSE