Provider Demographics
NPI:1205443660
Name:TERRY, CANDIS ERIN
Entity type:Individual
Prefix:
First Name:CANDIS
Middle Name:ERIN
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDIS
Other - Middle Name:ERIN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1631 NW SPIRIT CT E
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9515
Mailing Address - Country:US
Mailing Address - Phone:208-406-3775
Mailing Address - Fax:
Practice Address - Street 1:1631 NW SPIRIT CT E
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9515
Practice Address - Country:US
Practice Address - Phone:360-447-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61210181101Y00000X
WAMC61210204101YM0800X
101YM0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program