| Doctor Name: | DR. TERRY J BRENNER |
| NPI Number: | 1063721066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 2083 |
| Business Practice Address: | 8495 Crater Lake Hwy White City, OR - 975033011 |
| Business Phone Number: | 5418262111 |
| Business Fax Number: | |
| Mailing Address: | 9355 Jornada Ln Apt 6, ATASCADERO |
| State: | CA |
| Postal Code: | 934225859 |
| Phone Number: | 5039999894 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2010 |
| NPI Last Update Date: | 09/25/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2083 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |