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NPI Code Detail

MEDICARE: DR. TERRENCE (TERRY) H ANDERSON M.S.,PSY.D,LMFT

MEDICARE: DR. TERRENCE (TERRY) H ANDERSON M.S.,PSY.D,LMFT
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
1106H00000XMarriage & Family Therapist50616CA

General Provider Information

NPI Number : 1518225226
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRENCE (TERRY) H ANDERSON M.S.,PSY.D,LMFT
Provider Business Mailing Address
First Line : 18452 DURFEE CIR
Second Line :
City : VILLA PARK
State : CA
Zip : 92861-4520
Country : US
Telephone Number : 714-997-9262
Fax Number :
Provider Business Practice Location Address
First Line : 228 W MAIN ST
Second Line :
City : TUSTIN
State : CA
Zip : 92780-4320
Country : US
Telephone Number : 714-457-4543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2012
Last Update Date : 09/18/2012

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