Provider Demographics
NPI:1790442804
Name:BUKOWSKI, TERRI K (LPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:K
Last Name:BUKOWSKI
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 1:314 TWIN BENDS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-2884
Mailing Address - Country:US
Mailing Address - Phone:254-855-3547
Mailing Address - Fax:
Practice Address - Street 1:314 TWIN BENDS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-2884
Practice Address - Country:US
Practice Address - Phone:254-855-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71280101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor