Provider Demographics
NPI:1154593200
Name:MATSON, TERRI (LAC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:MATSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0470
Mailing Address - Country:US
Mailing Address - Phone:207-323-6662
Mailing Address - Fax:207-956-5722
Practice Address - Street 1:8 JESSE ROBBINS RD STE H
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7510
Practice Address - Country:US
Practice Address - Phone:207-323-6662
Practice Address - Fax:207-956-5722
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC597171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAC597OtherVETERAN ADMINISTRATION