Provider Demographics
NPI:1720326911
Name:CHITWOOD, TERRI M (MASTERS OF EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:M
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:MASTERS OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34363 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-9097
Mailing Address - Country:US
Mailing Address - Phone:918-647-3687
Mailing Address - Fax:
Practice Address - Street 1:2104 N BROADWAY ST UNIT A
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2538
Practice Address - Country:US
Practice Address - Phone:918-647-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171998101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor