Provider Demographics
NPI:1295099422
Name:DICKENS LANDRETH, TERRI LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LOUISE
Last Name:DICKENS LANDRETH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LOUISE
Other - Last Name:DICKENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:78852 EASTREGAARD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OR
Mailing Address - Zip Code:97818-9642
Mailing Address - Country:US
Mailing Address - Phone:541-969-3494
Mailing Address - Fax:541-481-5400
Practice Address - Street 1:19550 AMBER MEADOW DR STE 130
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3526
Practice Address - Country:US
Practice Address - Phone:541-969-3494
Practice Address - Fax:541-550-2906
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103TS0200X
ORL41401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool