Provider Demographics
NPI:1891702502
Name:SCHENK, TERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:SCHENK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23120 ALICIA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1212
Mailing Address - Country:US
Mailing Address - Phone:949-582-8606
Mailing Address - Fax:949-544-5821
Practice Address - Street 1:23120 ALICIA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1212
Practice Address - Country:US
Practice Address - Phone:949-582-8606
Practice Address - Fax:949-544-5821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10398103TC0700X
CAMFT20345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist