Healthcare Provider Details

I. General information

NPI: 1558473876
Provider Name (Legal Business Name): TERRY S. GOCK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9353 EAST VALLEY BLVD.
ROSEMEAD CA
91177-1934
US

IV. Provider business mailing address

9353 EAST VALLEY BLVD.
ROSEMEAD CA
91177-1934
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-9922
  • Fax: 626-287-2988
Mailing address:
  • Phone: 626-398-9922
  • Fax: 626-287-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY7206
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7206
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY7206
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY7206
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY7206
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: