Provider Demographics
NPI:1033366117
Name:MASHBURN, TERRY LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1373
Mailing Address - Country:US
Mailing Address - Phone:205-276-2419
Mailing Address - Fax:205-655-3851
Practice Address - Street 1:128 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1373
Practice Address - Country:US
Practice Address - Phone:205-276-2419
Practice Address - Fax:205-655-3851
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7976101YM0800X
AL2445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health