Provider Demographics
NPI:1598279556
Name:COLLEY, TERRY A (LPC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:COLLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PROVIDENCE MAIN ST NW UNIT 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4917
Mailing Address - Country:US
Mailing Address - Phone:256-937-1305
Mailing Address - Fax:
Practice Address - Street 1:220 PROVIDENCE MAIN ST NW UNIT 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4917
Practice Address - Country:US
Practice Address - Phone:256-937-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3250OtherALABAMA BOARD OF EXAMINERS IN COUNSELING