Provider Demographics
NPI:1578264768
Name:TERN, DAOTHID (DT)
Entity Type:Individual
Prefix:MR
First Name:DAOTHID
Middle Name:
Last Name:TERN
Suffix:
Gender:M
Credentials:DT
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:TERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DT
Mailing Address - Street 1:3639 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6847
Mailing Address - Country:US
Mailing Address - Phone:206-695-7600
Mailing Address - Fax:
Practice Address - Street 1:3639 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6847
Practice Address - Country:US
Practice Address - Phone:206-695-7600
Practice Address - Fax:206-695-7606
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor