Provider Demographics
NPI:1689123242
Name:TERRY, JENNIFER (ALC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 COUNTY ROAD 30 E
Mailing Address - Street 2:
Mailing Address - City:BERRY
Mailing Address - State:AL
Mailing Address - Zip Code:35546-3038
Mailing Address - Country:US
Mailing Address - Phone:205-544-1998
Mailing Address - Fax:
Practice Address - Street 1:85 N WALSTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-8640
Practice Address - Country:US
Practice Address - Phone:205-384-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2730101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health