Provider Demographics
NPI:1023368602
Name:NIGHSWANGER, TERRANCE W (LCPC)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:W
Last Name:NIGHSWANGER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 W PIONEER PKWY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1835
Mailing Address - Country:US
Mailing Address - Phone:309-648-9939
Mailing Address - Fax:306-692-2052
Practice Address - Street 1:2000 W PIONEER PKWY
Practice Address - Street 2:SUITE 20
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1835
Practice Address - Country:US
Practice Address - Phone:309-648-9939
Practice Address - Fax:306-692-2052
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health