Provider Demographics
NPI:1851825194
Name:BLACKMON, TERRY
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:BLACKMON
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2021 ZACH SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-820-4737
Mailing Address - Fax:
Practice Address - Street 1:2021 ZACH SCOTT ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-820-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8392103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst