Provider Demographics
NPI:1508632753
Name:SHORT, TERRAH ELIZABETH (SUDPT)
Entity Type:Individual
Prefix:
First Name:TERRAH
Middle Name:ELIZABETH
Last Name:SHORT
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 F ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5187
Mailing Address - Country:US
Mailing Address - Phone:206-473-0029
Mailing Address - Fax:
Practice Address - Street 1:1603 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3644
Practice Address - Country:US
Practice Address - Phone:360-647-4266
Practice Address - Fax:360-788-7181
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61251698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)