Provider Demographics
NPI:1164760682
Name:JEFFERSON, TERRI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:519 TISDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3319
Mailing Address - Country:US
Mailing Address - Phone:517-927-4989
Mailing Address - Fax:517-927-4989
Practice Address - Street 1:4710 W SAGINAW HWY STE 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2654
Practice Address - Country:US
Practice Address - Phone:517-816-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006592101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor