MEDICARE: DR. ANTHONY ITTNER TERNDRUP LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	FELLOW6813
2	101YP2500X	Professional Counselor	C1233	OR
3	106H00000X	Marriage & Family Therapist	T0367	OR
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184762916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY ITTNER TERNDRUP LMHC

Provider Business Mailing Address
First Line	:	PO BOX 93
Second Line	:
City	:	DEER HARBOR
State	:	WA
Zip	:	98243-0093
Country	:	US
Telephone Number	:	360-230-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W STEWART RD STE 108
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9607
Country	:	US
Telephone Number	:	360-340-9874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/01/2024

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