Provider Demographics
NPI:1518291871
Name:REA, TERRA L (PSYD, PLLC)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:L
Last Name:REA
Suffix:
Gender:F
Credentials:PSYD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 COLUMBIA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4311
Mailing Address - Country:US
Mailing Address - Phone:360-653-0374
Mailing Address - Fax:360-658-0219
Practice Address - Street 1:1106 COLUMBIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4311
Practice Address - Country:US
Practice Address - Phone:360-653-0374
Practice Address - Fax:360-658-0219
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60110632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical