Provider Demographics
NPI:1558971895
Name:WILLIAMS, TERRY JEAN (BS, QMHA, CADC-R)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BS, QMHA, CADC-R
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:JEAN
Other - Last Name:BRODKORB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 PEARL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3570
Mailing Address - Country:US
Mailing Address - Phone:417-995-3865
Mailing Address - Fax:
Practice Address - Street 1:1255 PEARL ST STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3570
Practice Address - Country:US
Practice Address - Phone:417-995-3865
Practice Address - Fax:415-881-1505
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)