Provider Demographics
NPI:1407404577
Name:MIDGETT, TERRA (INTERN)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:MIDGETT
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NE BELKNAP CT STE 205
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5115
Mailing Address - Country:US
Mailing Address - Phone:503-560-5822
Mailing Address - Fax:
Practice Address - Street 1:4950 NE BELKNAP CT STE 205
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5115
Practice Address - Country:US
Practice Address - Phone:503-560-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health