Provider Demographics
NPI:1801397153
Name:TERRAZAS, LAURA GUADALUPE (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GUADALUPE
Last Name:TERRAZAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NW BUCKLIN HILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8363
Mailing Address - Country:US
Mailing Address - Phone:360-337-2222
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 215
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8363
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-20-137186106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty