Provider Demographics
NPI:1649241043
Name:TERRY, LYNN H (LPE)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:H
Last Name:TERRY
Suffix:
Gender:M
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6478
Mailing Address - Country:US
Mailing Address - Phone:501-624-7111
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:125 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-624-7111
Practice Address - Fax:501-620-5109
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR77-20EI103TC0700X
AR77-20 LPE-I101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228114719Medicaid
AR5S574OtherBLUE CROSS & BLUE SHIELD