Active NPI
David L Terletzky, PSYD
- Clinical Psychologist
- Beaverton, OR
National Provider Identifier
1487877379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1283
- Practice address
- 4900 SW Griffith Dr
Suite 161
Beaverton, OR 97005 - Phone
- (503) 526-0138
- Fax
- (503) 213-6018
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1283 | OR | Primary |
| Clinical Psychologist | 103TC0700X | PY 2250 | WA |
Addresses
Primary practice location
4900 SW Griffith Dr
Suite 161
Beaverton, OR 97005
Mailing address
4900 SW Griffith Dr
Suite 161
Beaverton, OR 97005
Phone (503) 526-0138
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1283 | OR | MD | Clinical Psychologist |
| PY 2250 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487877379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 SW GRIFFITH DR",
"address_2": "SUITE 161",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97005",
"telephone_number": "503-526-0138",
"fax_number": "503-213-6018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 SW GRIFFITH DR",
"address_2": "SUITE 161",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97005",
"telephone_number": "503-526-0138",
"fax_number": "503-213-6018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERLETZKY",
"first_name": "DAVID",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1283",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY 2250",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.