Basic Information
| Provider Information | |||||||||
| NPI: | 1700920451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEREN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 259 | ||||||||
| Address2: | |||||||||
| City: | WHITMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960960259 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2640 BRESLAUER WAY | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960014246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302255200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | X | Other Service Providers | Case Manager/Care Coordinator | 225C00000X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.