Provider Demographics
NPI:1255849980
Name:TERRY, RODNEY D
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:D
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 S UNION AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4508
Mailing Address - Country:US
Mailing Address - Phone:701-318-8835
Mailing Address - Fax:
Practice Address - Street 1:4509 S UNION AVE APT 3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4508
Practice Address - Country:US
Practice Address - Phone:701-318-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor