Provider Demographics
NPI:1093841298
Name:WINGATE, TERILEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERILEE
Middle Name:
Last Name:WINGATE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 PACIFIC AVE SE STE A6
Mailing Address - Street 2:PMB 308
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2177
Mailing Address - Country:US
Mailing Address - Phone:360-789-7918
Mailing Address - Fax:
Practice Address - Street 1:3430 PACIFIC AVE SE STE A6
Practice Address - Street 2:PMB 308
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2177
Practice Address - Country:US
Practice Address - Phone:360-789-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist