Provider Demographics
NPI:1720532328
Name:ANDERSON, TERRA (BC-DMT)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 SE BELMONT ST # 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4247
Mailing Address - Country:US
Mailing Address - Phone:503-773-4700
Mailing Address - Fax:
Practice Address - Street 1:3430 SE BELMONT ST # 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4247
Practice Address - Country:US
Practice Address - Phone:503-773-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health