Provider Demographics
NPI:1588641286
Name:TERRY, JULIA ANGELINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:ANGELINA
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9606
Mailing Address - Country:US
Mailing Address - Phone:541-292-6225
Mailing Address - Fax:541-292-6225
Practice Address - Street 1:1245 N RIVERSIDE AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4655
Practice Address - Country:US
Practice Address - Phone:541-292-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical