MEDICARE: TERRENCE CHRISTOPHER IRELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1467602318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRENCE CHRISTOPHER IRELAND

Provider Business Mailing Address
First Line	:	6235 RIVER CREST DR STE N
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0758
Country	:	US
Telephone Number	:	951-653-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6235 RIVER CREST DR STE N
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0758
Country	:	US
Telephone Number	:	951-653-7561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	03/08/2024

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Directions to “ TERRENCE CHRISTOPHER IRELAND ” Practice Location

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