Provider Demographics
NPI:1437895935
Name:TERRY, TERESA (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 OAK RD
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:TX
Mailing Address - Zip Code:78950-4862
Mailing Address - Country:US
Mailing Address - Phone:832-687-7928
Mailing Address - Fax:
Practice Address - Street 1:3801 KIRBY DR STE 344
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4159
Practice Address - Country:US
Practice Address - Phone:832-303-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty