Provider Demographics
NPI:1336527027
Name:BASOLO, TERRY (MPA, MA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BASOLO
Suffix:
Gender:M
Credentials:MPA, MA
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:BLAINE
Other - Last Name:BASOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1000 MINOR AVE APT 1404
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1398
Mailing Address - Country:US
Mailing Address - Phone:208-720-6253
Mailing Address - Fax:
Practice Address - Street 1:1000 MINOR AVE APT 1404
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1398
Practice Address - Country:US
Practice Address - Phone:208-720-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health