Provider Demographics
NPI:1831250224
Name:MCCLANAHAN, TERRY MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:820 LAS GALLINAS AVE
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3410
Mailing Address - Country:US
Mailing Address - Phone:415-444-3075
Mailing Address - Fax:415-444-3019
Practice Address - Street 1:820 LAS GALLINAS AVE
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3410
Practice Address - Country:US
Practice Address - Phone:415-444-3075
Practice Address - Fax:415-444-3019
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY20124103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral