Provider Demographics
NPI:1114518156
Name:RASMUSSEN, TERRY (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 3RD ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1003
Mailing Address - Country:US
Mailing Address - Phone:208-565-8213
Mailing Address - Fax:208-845-6059
Practice Address - Street 1:1217 3RD ST S STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1003
Practice Address - Country:US
Practice Address - Phone:208-565-8213
Practice Address - Fax:208-845-6059
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health