Provider Demographics
NPI:1316916034
Name:HEATH, TERRY LYNN (M ED)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:HEATH
Suffix:
Gender:M
Credentials:M ED
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 555
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-0555
Mailing Address - Country:US
Mailing Address - Phone:253-967-1447
Mailing Address - Fax:253-967-1199
Practice Address - Street 1:BLDG 2006A /LIGGET AVE
Practice Address - Street 2:
Practice Address - City:FORT LEWIS
Practice Address - State:WA
Practice Address - Zip Code:98433-5000
Practice Address - Country:US
Practice Address - Phone:253-967-1447
Practice Address - Fax:253-967-1199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001248101YA0400X
WALH00007560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health