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NPI Code Detail

MEDICARE: TERRY SHINES MSW

MEDICARE: TERRY SHINES MSW
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
1101YM0800XMental Health CounselorRC00019272WA

General Provider Information

NPI Number : 1417996422
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY SHINES MSW
Provider Business Mailing Address
First Line : 2912 W ELLA ST
Second Line :
City : PASCO
State : WA
Zip : 99301-3203
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-1582
Provider Business Practice Location Address
First Line : 840 E PLUM ST
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1874
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-1582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/08/2007

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Directions to “ TERRY SHINES MSW” Practice Location

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