Provider Demographics
NPI:1457844953
Name:TERRA THERAPIES, PLLC
Entity Type:Organization
Organization Name:TERRA THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-907-0022
Mailing Address - Street 1:4113 MARKS PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7900
Mailing Address - Country:US
Mailing Address - Phone:817-907-0022
Mailing Address - Fax:817-945-1456
Practice Address - Street 1:1706 ENDERLY PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4122
Practice Address - Country:US
Practice Address - Phone:817-907-0022
Practice Address - Fax:817-945-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649515198OtherINSURANCE PANELS