Provider Demographics
NPI:1770663585
Name:TERRY, LEA MICHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2760
Mailing Address - Country:US
Mailing Address - Phone:307-632-9362
Mailing Address - Fax:307-637-6852
Practice Address - Street 1:510 W 29TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2760
Practice Address - Country:US
Practice Address - Phone:307-632-9362
Practice Address - Fax:307-637-6852
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY953101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor