MEDICARE: TERRY POND LPC

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	101YM0800X	Mental Health Counselor	R6034	OR

General Provider Information

NPI Number	:	1912549775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY POND LPC

Provider Business Mailing Address
First Line	:	1333 84TH PL SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97317-9179
Country	:	US
Telephone Number	:	503-990-2912
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 TRIANGLE DR SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4566
Country	:	US
Telephone Number	:	503-773-6809
Fax Number	:

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

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	02/26/2024

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Directions to “ TERRY POND LPC” Practice Location

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