Provider Demographics
NPI:1043305253
Name:JAMES, TERRI SUE (MED)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:SUE
Last Name:JAMES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 2ND AVE. SOUTH
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333
Mailing Address - Country:US
Mailing Address - Phone:208-788-5625
Mailing Address - Fax:208-788-5692
Practice Address - Street 1:220 2ND AVE. SOUTH
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333
Practice Address - Country:US
Practice Address - Phone:208-788-5625
Practice Address - Fax:208-788-5692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 79101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional