Provider Demographics
NPI:1083060966
Name:TADLOCK-SMITH, TERRA S (LPCC-S)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:S
Last Name:TADLOCK-SMITH
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N COLUMBUS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2538
Mailing Address - Country:US
Mailing Address - Phone:740-653-6500
Mailing Address - Fax:740-653-6501
Practice Address - Street 1:647 HILL RD N
Practice Address - Street 2:STE. B
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9168
Practice Address - Country:US
Practice Address - Phone:614-833-6900
Practice Address - Fax:614-833-6903
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008315-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health