Healthcare Provider Details

I. General information

NPI: 1588641286
Provider Name (Legal Business Name): JULIA ANGELINA TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 N RIVERSIDE AVE SUITE 20
MEDFORD OR
97501-4655
US

IV. Provider business mailing address

300 OAK VALLEY DR
TALENT OR
97540-9606
US

V. Phone/Fax

Practice location:
  • Phone: 541-292-6225
  • Fax:
Mailing address:
  • Phone: 541-292-6225
  • Fax: 541-292-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2339
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: