Provider Demographics
NPI:1225423122
Name:MARSHALL, TERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NE SANDY BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1882
Mailing Address - Country:US
Mailing Address - Phone:503-975-9596
Mailing Address - Fax:
Practice Address - Street 1:3800 NE SANDY BLVD STE 215
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1882
Practice Address - Country:US
Practice Address - Phone:503-975-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0836106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist