Provider Demographics
NPI:1962443457
Name:HARVEY-LINTZ, TERRI (PHD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HARVEY-LINTZ
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 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:#501
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:310-613-2414
Mailing Address - Fax:805-494-8379
Practice Address - Street 1:3760 MOTOR AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6404
Practice Address - Country:US
Practice Address - Phone:310-838-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY152870Medicaid
CA680010197OtherRAILROAD MEDICARE
CA680010197OtherRAILROAD MEDICARE
CACP15287Medicare PIN