Provider Demographics
NPI:1801301932
Name:WHITE, TERRELL JENSEN (LMFT)
Entity type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:JENSEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:JENSEN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2511 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BALLARD
Mailing Address - State:CA
Mailing Address - Zip Code:93463
Mailing Address - Country:US
Mailing Address - Phone:805-451-1337
Mailing Address - Fax:
Practice Address - Street 1:2511 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BALLARD
Practice Address - State:CA
Practice Address - Zip Code:93463
Practice Address - Country:US
Practice Address - Phone:805-451-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT29341106H00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT29341OtherSTATE LICENSE