Healthcare Provider Details

I. General information

NPI: 1316916034
Provider Name (Legal Business Name): TERRY LYNN HEATH M. ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 2006A /LIGGET AVE
FORT LEWIS WA
98433-5000
US

IV. Provider business mailing address

PO BOX 555
DUPONT WA
98327-0555
US

V. Phone/Fax

Practice location:
  • Phone: 253-967-1447
  • Fax: 253-967-1199
Mailing address:
  • Phone: 253-967-1447
  • Fax: 253-967-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001248
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007560
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: