Provider Demographics
NPI:1346521184
Name:PETERSON, TERRY (MSW)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S WASHINGTON ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3719
Mailing Address - Country:US
Mailing Address - Phone:509-328-9909
Mailing Address - Fax:
Practice Address - Street 1:9 S WASHINGTON ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3719
Practice Address - Country:US
Practice Address - Phone:509-328-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health