Provider Demographics
NPI:1699982009
Name:SCHOMBURG, TERRENCE EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:EDWARD
Last Name:SCHOMBURG
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 1:2421 S UNION AVE
Mailing Address - Street 2:NO. 279
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1360
Mailing Address - Country:US
Mailing Address - Phone:253-686-8210
Mailing Address - Fax:253-503-6655
Practice Address - Street 1:2421 S UNION AVE
Practice Address - Street 2:NO. 279
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1360
Practice Address - Country:US
Practice Address - Phone:253-686-8210
Practice Address - Fax:253-503-6655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist