Provider Demographics
NPI:1629733936
Name:TERA BUERKLE LLC
Entity Type:Organization
Organization Name:TERA BUERKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:TERA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:859-359-8266
Mailing Address - Street 1:118 CONSTITUTION ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-2111
Mailing Address - Country:US
Mailing Address - Phone:859-359-8266
Mailing Address - Fax:
Practice Address - Street 1:118 CONSTITUTION ST STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-2111
Practice Address - Country:US
Practice Address - Phone:859-359-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841861689OtherNPI 1
KY289138OtherKENTUCKY BOARD OF LICENSURE FOR MARRIAGE AND FAMILY THERAPISTS