Provider Demographics
NPI:1922452234
Name:TERRY, MOLLY RAE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:RAE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:RAE
Other - Last Name:THEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 SHERBROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4607
Mailing Address - Country:US
Mailing Address - Phone:716-465-1902
Mailing Address - Fax:
Practice Address - Street 1:121 SHERBROOKE AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4607
Practice Address - Country:US
Practice Address - Phone:716-465-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007171-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health