Provider Demographics
NPI:1740415306
Name:MACKIE, TERRY GLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:GLEN
Last Name:MACKIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 CARRIAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3321
Mailing Address - Country:US
Mailing Address - Phone:412-366-7592
Mailing Address - Fax:
Practice Address - Street 1:414 GRANT ST
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1231
Practice Address - Country:US
Practice Address - Phone:412-741-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist