Provider Demographics
NPI:1356529846
Name:VIPOND, TERIL DAVIS (LCSW)
Entity type:Individual
Prefix:
First Name:TERIL
Middle Name:DAVIS
Last Name:VIPOND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14387 HIGHWAY 101 S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-8322
Mailing Address - Country:US
Mailing Address - Phone:541-661-0130
Mailing Address - Fax:541-469-4317
Practice Address - Street 1:370 9TH ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3432
Practice Address - Country:US
Practice Address - Phone:707-464-4349
Practice Address - Fax:707-464-4572
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32371041C0700X
CA256371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical