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General NPI Number Information
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NPI Number | 1073238432
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Entity Type | Individual
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Provider Name | BROOKE M TERRY
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Gender | Female
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE STE 5395
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City | PORTLAND
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State | OR
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Zip | 97239-3822
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Country | US
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Telephone | 323-393-3714
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5530
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City | BOSSIER CITY
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State | LA
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Zip | 71171-5530
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Country | US
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Telephone | 601-383-1985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R7934
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License Number State | OR
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