Provider Demographics
NPI:1942929559
Name:YANOVIAK, TERRI RAE (LCDCI)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:RAE
Last Name:YANOVIAK
Suffix:
Gender:F
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21819 MOORTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5968
Mailing Address - Country:US
Mailing Address - Phone:713-471-7265
Mailing Address - Fax:
Practice Address - Street 1:607 PARK GROVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5590
Practice Address - Country:US
Practice Address - Phone:800-685-9796
Practice Address - Fax:281-676-4444
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)