Provider Demographics
NPI:1013121805
Name:AULTMAN, TERRY T (MA LPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:T
Last Name:AULTMAN
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 N HIGHWAY 146
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-9081
Mailing Address - Country:US
Mailing Address - Phone:281-918-0152
Mailing Address - Fax:281-918-0151
Practice Address - Street 1:6236 N HIGHWAY 146
Practice Address - Street 2:SUITE 9
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-9081
Practice Address - Country:US
Practice Address - Phone:281-918-0152
Practice Address - Fax:281-918-0151
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183143003Medicaid
TX85196LOtherBLUE CROSS BLUE SHIELD