Provider Demographics
NPI:1083639041
Name:TERRELL, TAMERA LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:LYNN
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S ELM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6015
Mailing Address - Country:US
Mailing Address - Phone:940-300-2819
Mailing Address - Fax:469-574-5166
Practice Address - Street 1:415 S ELM ST
Practice Address - Street 2:#B
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6015
Practice Address - Country:US
Practice Address - Phone:940-300-2819
Practice Address - Fax:469-574-5166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health