Provider Demographics
NPI:1215533997
Name:GOLD, TERA HADASSAH (LPC)
Entity Type:Individual
Prefix:MS
First Name:TERA
Middle Name:HADASSAH
Last Name:GOLD
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 967
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0967
Mailing Address - Country:US
Mailing Address - Phone:503-396-3230
Mailing Address - Fax:503-468-0136
Practice Address - Street 1:4274 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2338
Practice Address - Country:US
Practice Address - Phone:503-396-3230
Practice Address - Fax:503-468-0136
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5529101Y00000X, 101YA0400X, 101YM0800X, 102L00000X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2174730Medicaid
OR500788856Medicaid