Healthcare Provider Details

I. General information

NPI: 1336076249
Provider Name (Legal Business Name): TERRY BASOLO & ASSOCIATES, PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HARBOR SQ LOOP NE UNIT B422
BAINBRIDGE ISLAND WA
98110-3423
US

IV. Provider business mailing address

8202 NE STATE HIGHWAY 104 STE 102-246
KINGSTON WA
98346-9454
US

V. Phone/Fax

Practice location:
  • Phone: 206-450-6223
  • Fax:
Mailing address:
  • Phone: 206-450-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TERRY BASOLO
Title or Position: OWNER
Credential: LMHC
Phone: 206-450-6223