Healthcare Provider Details

I. General information

NPI: 1578104808
Provider Name (Legal Business Name): TERENCE LAROME WEBSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S LUCILE ST
SEATTLE WA
98108-2435
US

IV. Provider business mailing address

419 S 2ND ST STE 2
RENTON WA
98057-2234
US

V. Phone/Fax

Practice location:
  • Phone: 206-849-7824
  • Fax:
Mailing address:
  • Phone: 206-849-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: