Provider Demographics
NPI:1568972230
Name:TERNER, MONIQUE (MED)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:TERNER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 NW THURMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2202
Mailing Address - Country:US
Mailing Address - Phone:503-451-5179
Mailing Address - Fax:
Practice Address - Street 1:2661 NW THURMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2202
Practice Address - Country:US
Practice Address - Phone:503-451-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health