Provider Demographics
NPI:1649687625
Name:VINCENT, TERI DELAYNE
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:DELAYNE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TERI
Other - Middle Name:DELAYNE
Other - Last Name:SWIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:358 S. OAKDALE
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-5793
Mailing Address - Fax:541-776-5798
Practice Address - Street 1:640 S. 2ND STREET
Practice Address - Street 2:FAMILY SOLUTIONS
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-665-0359
Practice Address - Fax:541-665-0358
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst