Provider Demographics
NPI:1356077705
Name:TERRA DUSA, PLLC
Entity Type:Organization
Organization Name:TERRA DUSA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LMHCA
Authorized Official - Phone:206-867-4547
Mailing Address - Street 1:12544 37TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4655
Mailing Address - Country:US
Mailing Address - Phone:206-483-4584
Mailing Address - Fax:
Practice Address - Street 1:12544 37TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4655
Practice Address - Country:US
Practice Address - Phone:206-867-4547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60939101OtherLICENSED MENTAL HEALTH COUNSELOR
WA1578809786OtherPROVIDER NPI
WANT61109144OtherNATUROPATHIC DOCTOR LICENSE