Provider Demographics
NPI:1083198451
Name:MACDONALD, TERRY (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14132 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6470
Mailing Address - Country:US
Mailing Address - Phone:425-275-1008
Mailing Address - Fax:
Practice Address - Street 1:19125 N CREEK PKWY STE 115
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8000
Practice Address - Country:US
Practice Address - Phone:425-921-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60835893103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling