Provider Demographics
NPI:1871582395
Name:DAVID, TERRI (MSMFT)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14668 VALLEY VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4112
Mailing Address - Country:US
Mailing Address - Phone:818-635-1644
Mailing Address - Fax:818-713-8585
Practice Address - Street 1:14156 MAGNOLIA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:818-635-1644
Practice Address - Fax:818-905-6686
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)