Healthcare Provider Details

I. General information

NPI: 1598691941
Provider Name (Legal Business Name): TERA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 AIRBORNE RD
WILMINGTON OH
45177-8969
US

IV. Provider business mailing address

6980 ABERNATHY RD
LYNCHBURG OH
45142-9298
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-6921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: