Provider Demographics
NPI:1568693307
Name:TERRY, SHAYNE L (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:SHAYNE
Middle Name:L
Last Name:TERRY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2626 JBS PKWY
Mailing Address - Street 2:STE C 129
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1958
Mailing Address - Country:US
Mailing Address - Phone:432-333-1333
Mailing Address - Fax:432-333-1335
Practice Address - Street 1:2626 JBS PKWY
Practice Address - Street 2:STE C 129
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1958
Practice Address - Country:US
Practice Address - Phone:432-333-1333
Practice Address - Fax:432-333-1335
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6040S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional