Provider Demographics
NPI:1679634752
Name:ROONEY, TERENCE MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:MICHAEL
Last Name:ROONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2880
Mailing Address - Country:US
Mailing Address - Phone:530-458-0520
Mailing Address - Fax:530-458-7751
Practice Address - Street 1:162 E CARSON ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2880
Practice Address - Country:US
Practice Address - Phone:530-458-0520
Practice Address - Fax:530-458-7751
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist