Provider Demographics
NPI:1285731802
Name:BARRETT, TERENCE W (PHD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:W
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 UNIVERSITY DR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4667
Mailing Address - Country:US
Mailing Address - Phone:701-237-4542
Mailing Address - Fax:
Practice Address - Street 1:115 UNIVERSITY DR N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4667
Practice Address - Country:US
Practice Address - Phone:701-237-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND217103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10177OtherBLUE CROSS BLUE SHIELD
MN2163306OtherCIGNA BEHAVIORAL HEALTH
MN68337BAOtherBLUE CROSS BLUE SHIELD
ND16913Medicaid
MN2163306OtherCIGNA BEHAVIORAL HEALTH