Basic Information
| Provider Information | |||||||||
| NPI: | 1598121618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | TERRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3413 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902477113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106282623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 N PACIFIC COAST HWY | ||||||||
| Address2: | #200A | ||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902772162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103161610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2016 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 72305 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.