Provider Demographics
NPI:1104992098
Name:TERRY, CATHY (MFT)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:DIANE
Other - Last Name:ZWIEBEL-TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:505 W FOOTHILL BLVD
Mailing Address - Street 2:# 3
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2021
Mailing Address - Country:US
Mailing Address - Phone:626-357-8188
Mailing Address - Fax:626-357-8188
Practice Address - Street 1:505 W FOOTHILL BLVD
Practice Address - Street 2:# 3
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2021
Practice Address - Country:US
Practice Address - Phone:626-357-8188
Practice Address - Fax:626-357-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist