Provider Demographics
NPI:1902643380
Name:TERRY, DAVID SEAN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SEAN
Last Name:TERRY
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 EVANGELISTA ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-4012
Mailing Address - Country:US
Mailing Address - Phone:540-818-3505
Mailing Address - Fax:
Practice Address - Street 1:5951 EVANGELISTA ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-4012
Practice Address - Country:US
Practice Address - Phone:540-818-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional