Provider Demographics
NPI:1801093760
Name:JONES HENDERSON, TERILYN I (PHD)
Entity type:Individual
Prefix:DR
First Name:TERILYN
Middle Name:I
Last Name:JONES HENDERSON
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 1:2500 W MANCHESTER BLVD
Mailing Address - Street 2:A FOSTER ADOPTION AGENCY
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 W MANCHESTER BLVD
Practice Address - Street 2:A FOSTER ADOPTION AGENCY
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2520
Practice Address - Country:US
Practice Address - Phone:323-750-5855
Practice Address - Fax:323-750-5885
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS-2007086103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily