Healthcare Provider Details

I. General information

NPI: 1306081211
Provider Name (Legal Business Name): TERI JEAN MCHALE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 ARTESIA BLVD #B346
REDONDO BEACH CA
90278-3073
US

IV. Provider business mailing address

2110 ARTESIA BLVD #B346
REDONDO BEACH CA
90278-3073
US

V. Phone/Fax

Practice location:
  • Phone: 310-421-1875
  • Fax:
Mailing address:
  • Phone: 310-421-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB33531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: