Provider Demographics
NPI:1669973152
Name:GWENDOLYN NELSON-TERRY, LMFT
Entity type:Organization
Organization Name:GWENDOLYN NELSON-TERRY, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:NELSON-TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:415-678-0186
Mailing Address - Street 1:1760 S EL CAMINO REAL UNIT D206
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4975
Mailing Address - Country:US
Mailing Address - Phone:415-678-0186
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2657
Practice Address - Country:US
Practice Address - Phone:619-383-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty