Provider Demographics
NPI:1316201635
Name:MENOTTI, TERRI GWEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:GWEN
Last Name:MENOTTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 SLAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:TX
Mailing Address - Zip Code:76270-2713
Mailing Address - Country:US
Mailing Address - Phone:940-367-1588
Mailing Address - Fax:
Practice Address - Street 1:215 W MULBERRY ST
Practice Address - Street 2:STE.A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6061
Practice Address - Country:US
Practice Address - Phone:940-367-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23740103T00000X
TX6191103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist