Provider Demographics
NPI:1629715982
Name:TER KEURST, FRANKIE LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:LEE
Last Name:TER KEURST
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 LOVELL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2352
Mailing Address - Country:US
Mailing Address - Phone:321-514-0365
Mailing Address - Fax:
Practice Address - Street 1:995 LOVELL DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2352
Practice Address - Country:US
Practice Address - Phone:321-514-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty