Provider Demographics
NPI:1003330994
Name:TERPENING, MOLLIE FAYE (LPC)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:FAYE
Last Name:TERPENING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503010
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-890-5180
Mailing Address - Fax:541-770-5070
Practice Address - Street 1:15 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7444
Practice Address - Country:US
Practice Address - Phone:541-890-5180
Practice Address - Fax:541-770-5070
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5173101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500729183Medicaid