Provider Demographics
NPI:1053942805
Name:BARKER, TERAH JO
Entity type:Individual
Prefix:
First Name:TERAH
Middle Name:JO
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERAH
Other - Middle Name:JO
Other - Last Name:HEMMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 SOUTH PINE ST.
Mailing Address - Street 2:SUITE 505
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-292-4354
Mailing Address - Fax:855-373-4004
Practice Address - Street 1:4301 SOUTH PINE ST.
Practice Address - Street 2:SUITE 505
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-292-4354
Practice Address - Fax:855-373-4004
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61004018106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician