Provider Demographics
NPI:1174998678
Name:ESHOM, TERRIE (LMHC)
Entity type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:
Last Name:ESHOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 CALIFORNIA AVE SW UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2495
Mailing Address - Country:US
Mailing Address - Phone:206-419-2989
Mailing Address - Fax:
Practice Address - Street 1:2743 CALIFORNIA AVE SW UNIT 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2495
Practice Address - Country:US
Practice Address - Phone:206-419-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60754240101YM0800X
WAMC60553211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60553211OtherLIC # (LMHCA)