Provider Demographics
NPI:1881234847
Name:CHRISTOPHER, TERRAL M II
Entity type:Individual
Prefix:MR
First Name:TERRAL
Middle Name:M
Last Name:CHRISTOPHER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26560 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6354
Mailing Address - Country:US
Mailing Address - Phone:951-587-7260
Mailing Address - Fax:
Practice Address - Street 1:27720 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2610
Practice Address - Country:US
Practice Address - Phone:951-699-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2310606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst