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General NPI Number Information
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NPI Number | 1083163653
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Entity Type | Individual
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Provider Name | TERRY SOOHOO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 40844 MISSION BLVD
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City | FREMONT
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State | CA
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Zip | 94539-3800
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Country | US
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Telephone | 510-885-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 40844 MISSION BLVD
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City | FREMONT
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State | CA
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Zip | 94539-3800
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Country | US
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Telephone | 510-668-0628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY11558
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT19783
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License Number State | CA
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