Basic Information
| Provider Information | |||||||||
| NPI: | 1871582395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS.MFT. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14668 VALLEY VISTA BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914034112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186351644 | ||||||||
| FaxNumber: | 8187138585 | ||||||||
| Practice Location | |||||||||
| Address1: | 14156 MAGNOLIA BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186351644 | ||||||||
| FaxNumber: | 8189056686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 30801 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.