Provider Demographics
NPI:1891465928
Name:TERRY, RACHEL L
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 S HURSTBOURNE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4112
Mailing Address - Country:US
Mailing Address - Phone:502-915-8343
Mailing Address - Fax:
Practice Address - Street 1:2831 S HURSTBOURNE PKWY STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4112
Practice Address - Country:US
Practice Address - Phone:502-915-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst