Provider Demographics
NPI:1992084537
Name:WAN, TERENCE
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:WAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7170 N FINANCIAL DR
Practice Address - Street 2:SUITE 135
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2939
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)