Provider Demographics
NPI:1497179931
Name:JANELLE, TERRY (LPCC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:JANELLE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:JANELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:117 E 18TH ST # 141
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3752
Mailing Address - Country:US
Mailing Address - Phone:270-313-2988
Mailing Address - Fax:
Practice Address - Street 1:1727 SWEENEY ST STE 102
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3834
Practice Address - Country:US
Practice Address - Phone:270-231-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1596101YP2500X
KY103832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100276810Medicaid