Provider Demographics
NPI:1013297068
Name:SMITH, TERRIEE (MS)
Entity type:Individual
Prefix:
First Name:TERRIEE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6744
Mailing Address - Country:US
Mailing Address - Phone:321-537-0558
Mailing Address - Fax:321-265-4885
Practice Address - Street 1:100 NELSON AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6744
Practice Address - Country:US
Practice Address - Phone:321-537-0558
Practice Address - Fax:321-265-4885
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14043101YM0800X
171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator