Provider Demographics
NPI:1700082476
Name:EDWARDS, TERRY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:
Last Name:EDWARDS
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 1:886 VIA JUAN PABLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-9323
Mailing Address - Country:US
Mailing Address - Phone:831-623-4272
Mailing Address - Fax:
Practice Address - Street 1:17705 HALE AVE STE H6
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4347
Practice Address - Country:US
Practice Address - Phone:831-750-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist