Basic Information
| Provider Information | |||||||||
| NPI: | 1982780623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 TONGASS DR | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998359416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079668611 | ||||||||
| FaxNumber: | 9079668627 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 TONGASS DR | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998359416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079668611 | ||||||||
| FaxNumber: | 9079668627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MH3681 | FL | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | MH3681 | FL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | MH3681 | FL | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 579 | AK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MH3681 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.