Provider Demographics
NPI:1184268609
Name:LIVELY, TERRY LYNN (CPCP)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LYNN
Last Name:LIVELY
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7575 DR PHILLIPS BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7220
Mailing Address - Country:US
Mailing Address - Phone:407-982-4876
Mailing Address - Fax:407-650-2754
Practice Address - Street 1:1478 FM 2673
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4583
Practice Address - Country:US
Practice Address - Phone:407-982-4876
Practice Address - Fax:407-650-2754
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other