Provider Demographics
NPI:1144372392
Name:BASILE, TERRY J (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:J
Last Name:BASILE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SAINT GEORGE LN STE 5
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1311
Mailing Address - Country:US
Mailing Address - Phone:530-588-2620
Mailing Address - Fax:530-852-8505
Practice Address - Street 1:2260 SAINT GEORGE LN STE 5
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1311
Practice Address - Country:US
Practice Address - Phone:530-588-2620
Practice Address - Fax:530-852-8505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist