Provider Demographics
NPI:1942489505
Name:KAREN M TERRY PHD PSYCHOLOGICAL SRV
Entity Type:Organization
Organization Name:KAREN M TERRY PHD PSYCHOLOGICAL SRV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-860-0580
Mailing Address - Street 1:5979 E LIVINGSTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2908
Mailing Address - Country:US
Mailing Address - Phone:614-860-0580
Mailing Address - Fax:614-860-0595
Practice Address - Street 1:5979 E LIVINGSTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2908
Practice Address - Country:US
Practice Address - Phone:614-860-0580
Practice Address - Fax:614-860-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHO81530Medicare PIN