Healthcare Provider Details

I. General information

NPI: 1386280725
Provider Name (Legal Business Name): TERRY KAY MILLER SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N 20TH AVE
PASCO WA
99301-3393
US

IV. Provider business mailing address

1307 TOTTEN AVE
RICHLAND WA
99354-3153
US

V. Phone/Fax

Practice location:
  • Phone: 509-792-1041
  • Fax: 509-792-1034
Mailing address:
  • Phone: 509-492-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number61233718
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60934850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: