Provider Demographics
NPI:1891852018
Name:COURTNEY-MILLER, TERRI (LPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:COURTNEY-MILLER
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 1:1529 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1811
Mailing Address - Country:US
Mailing Address - Phone:417-831-3893
Mailing Address - Fax:417-882-5517
Practice Address - Street 1:1736 E SUNSHINE ST
Practice Address - Street 2:SUITE 811
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1343
Practice Address - Country:US
Practice Address - Phone:417-882-4485
Practice Address - Fax:417-882-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor