Provider Demographics
NPI:1952659567
Name:TERRY, CALLIE AMANDA (MA-BCBA)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:AMANDA
Last Name:TERRY
Suffix:
Gender:F
Credentials:MA-BCBA
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:AMANDA
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-BCBA
Mailing Address - Street 1:490 S INTERSTATE 35 E
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7768
Mailing Address - Country:US
Mailing Address - Phone:940-369-7426
Mailing Address - Fax:855-217-6179
Practice Address - Street 1:490 S INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7768
Practice Address - Country:US
Practice Address - Phone:940-369-7426
Practice Address - Fax:855-217-6179
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-07-3673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst