Provider Demographics
NPI:1740471911
Name:MIDDLEBROOK, TERA LEE (LMHC)
Entity type:Individual
Prefix:MS
First Name:TERA
Middle Name:LEE
Last Name:MIDDLEBROOK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:103 ELLOWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9270
Mailing Address - Country:US
Mailing Address - Phone:360-918-6959
Mailing Address - Fax:360-623-1117
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-2385
Practice Address - Fax:360-414-2386
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60473719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health