Provider Demographics
NPI:1639267198
Name:MATTINGLY, TERRY HYER
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:HYER
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6210
Mailing Address - Country:US
Mailing Address - Phone:407-389-0920
Mailing Address - Fax:407-389-0920
Practice Address - Street 1:1675 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6210
Practice Address - Country:US
Practice Address - Phone:407-389-0920
Practice Address - Fax:407-389-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS843103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool