Provider Demographics
NPI:1578933958
Name:BURSEY, TERRI LYNNE (LPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNNE
Last Name:BURSEY
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 1:4104 FORSYTHE AVE
Mailing Address - Street 2:NONE
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2207
Mailing Address - Country:US
Mailing Address - Phone:318-450-0550
Mailing Address - Fax:318-410-1065
Practice Address - Street 1:1010 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5513
Practice Address - Country:US
Practice Address - Phone:318-410-1062
Practice Address - Fax:318-410-1065
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional