Provider Demographics
NPI:1346368339
Name:TERWILLIGER, TRACY (LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:TERWILLIGER
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 1:291 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6968
Mailing Address - Country:US
Mailing Address - Phone:501-520-8696
Mailing Address - Fax:
Practice Address - Street 1:1820 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6898
Practice Address - Country:US
Practice Address - Phone:501-463-4627
Practice Address - Fax:501-463-4629
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0611067101Y00000X
ARP0611065101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor