Provider Demographics
NPI:1235804451
Name:UPCHURCH-BUTLER, TERISSA LYNNE (PHD, LPC, LIMHP,)
Entity Type:Individual
Prefix:DR
First Name:TERISSA
Middle Name:LYNNE
Last Name:UPCHURCH-BUTLER
Suffix:
Gender:F
Credentials:PHD, LPC, LIMHP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71382
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35407-1382
Mailing Address - Country:US
Mailing Address - Phone:205-534-1938
Mailing Address - Fax:
Practice Address - Street 1:5927 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35453-1644
Practice Address - Country:US
Practice Address - Phone:205-534-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional