Provider Demographics
NPI:1184762916
Name:TERNDRUP, ANTHONY ITTNER (LMHC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ITTNER
Last Name:TERNDRUP
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:DEER HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98243-0093
Mailing Address - Country:US
Mailing Address - Phone:360-230-8388
Mailing Address - Fax:
Practice Address - Street 1:205 W STEWART RD STE 108
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-9607
Practice Address - Country:US
Practice Address - Phone:360-340-9874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FELLOW6813101YP1600X
ORC1233101YP2500X
ORT0367106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist