Provider Demographics
NPI:1639447659
Name:HOGAN, TERRY CONSTANCE (MS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:CONSTANCE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DENWOOD DR
Mailing Address - Street 2:DRIVE
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9127
Mailing Address - Country:US
Mailing Address - Phone:731-427-9281
Mailing Address - Fax:731-660-7512
Practice Address - Street 1:65 DENWWOD DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-668-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor