Active NPI
Terry J Brenner, PSY.D.
- Clinical Psychologist
- White City, OR
National Provider Identifier
1063721066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2083
- Practice address
- 8495 Crater Lake Hwy
White City, OR 97503-3011 - Phone
- (541) 826-2111
- NPI assigned
- Sep 25, 2010
- Last updated
- Sep 25, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2083 | OR | Primary |
Addresses
Primary practice location
8495 Crater Lake Hwy
White City, OR 97503-3011
Mailing address
9355 Jornada LN Apt 6
Atascadero, CA 93422-5859
Phone (503) 999-9894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2083 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285372800000",
"number": "1063721066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9355 JORNADA LN APT 6",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225859",
"telephone_number": "503-999-9894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8495 CRATER LAKE HWY",
"city": "WHITE CITY",
"state": "OR",
"postal_code": "975033011",
"telephone_number": "541-826-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "TERRY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-25",
"last_updated": "2010-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.