Provider Demographics
NPI:1073680948
Name:LEVY, TERRY MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32065 CASTLE CT
Mailing Address - Street 2:STE 325 EVERGREEN PSYCHOTHERAPY CTR
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-674-4029
Mailing Address - Fax:303-674-4078
Practice Address - Street 1:32065 CASTLE CT
Practice Address - Street 2:STE 325 EVERGREEN PSYCHOTHERAPY CTR
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-674-4029
Practice Address - Fax:303-674-4078
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical