Provider Demographics
NPI:1104053461
Name:WILENSKY, TERRANCE ALLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:ALLAN
Last Name:WILENSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7397
Mailing Address - Country:US
Mailing Address - Phone:214-735-7000
Mailing Address - Fax:
Practice Address - Street 1:4625 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7397
Practice Address - Country:US
Practice Address - Phone:214-735-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31990103TC1900X
MO01605103TC1900X
KS879103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling