Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | FELLOW6813 | |
N | 101YP2500X | Professional Counselor | C1233 | OR |
NPI | 1184762916 |
---|---|
Provider Name | Dr. Anthony Ittner Terndrup |
First Address | Friday Harbor, WA 98250-8057 |
Second Address | Friday Harbor, WA 98250-8057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 12/01/2017 |