Provider Demographics
NPI:1689906190
Name:DRISKILL, TERRY L (LPC#3601)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:DRISKILL
Suffix:
Gender:M
Credentials:LPC#3601
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PINE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71226-7904
Mailing Address - Country:US
Mailing Address - Phone:318-957-2530
Mailing Address - Fax:
Practice Address - Street 1:2106 LOOP RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3344
Practice Address - Country:US
Practice Address - Phone:318-435-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13588263OtherCAQH