Provider Demographics
NPI:1467754101
Name:TERRY, CHRISTEINE MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTEINE
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:STE 1360
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2555
Mailing Address - Country:US
Mailing Address - Phone:206-963-6313
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2555
Practice Address - Country:US
Practice Address - Phone:206-623-5825
Practice Address - Fax:206-623-5895
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60341032103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1467754101Medicaid