Provider Demographics
NPI:1902165376
Name:JHAWAR-TERRIS, GURKIRIT (MFT)
Entity Type:Individual
Prefix:
First Name:GURKIRIT
Middle Name:
Last Name:JHAWAR-TERRIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KITU
Other - Middle Name:
Other - Last Name:JHAWAR-TERRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:5 KELLER ST STE D
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2350
Mailing Address - Country:US
Mailing Address - Phone:707-776-6513
Mailing Address - Fax:
Practice Address - Street 1:5 KELLER ST STE D
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2350
Practice Address - Country:US
Practice Address - Phone:707-776-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist