Provider Demographics
NPI:1154855633
Name:TERPSTRA, WAYNE ALLEN JR (NCC, LMHC, CASAC,)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALLEN
Last Name:TERPSTRA
Suffix:JR
Gender:M
Credentials:NCC, LMHC, CASAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6611
Mailing Address - Country:US
Mailing Address - Phone:518-314-9412
Mailing Address - Fax:
Practice Address - Street 1:32 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6611
Practice Address - Country:US
Practice Address - Phone:518-314-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013406101YM0800X
NY31397101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)