Healthcare Provider Details

I. General information

NPI: 1285731802
Provider Name (Legal Business Name): TERENCE W BARRETT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 UNIVERSITY DR N
FARGO ND
58102-4667
US

IV. Provider business mailing address

115 UNIVERSITY DR N
FARGO ND
58102-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-4542
  • Fax:
Mailing address:
  • Phone: 701-237-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number217
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: