Provider Demographics
NPI:1578512133
Name:TEMPLEMAN, TERREL L (PHD)
Entity type:Individual
Prefix:
First Name:TERREL
Middle Name:L
Last Name:TEMPLEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2203
Mailing Address - Country:US
Mailing Address - Phone:541-278-2222
Mailing Address - Fax:541-276-8405
Practice Address - Street 1:135 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2203
Practice Address - Country:US
Practice Address - Phone:541-278-2222
Practice Address - Fax:541-276-8405
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR206003Medicaid
OR206003Medicaid