Provider Demographics
NPI:1194018010
Name:TERRY, BRANDY LYNN (LPCI)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:TERRY
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8196 N CEDAR SPRINGS RD APT Q7
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-2630
Mailing Address - Country:US
Mailing Address - Phone:801-400-2422
Mailing Address - Fax:
Practice Address - Street 1:560 S STATE ST STE G1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6397
Practice Address - Country:US
Practice Address - Phone:801-802-8608
Practice Address - Fax:801-221-1042
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health