Provider Demographics
NPI:1770651358
Name:FUSILIER, TERI BRINICK (LPC)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:BRINICK
Last Name:FUSILIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7448 LOVE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-4329
Mailing Address - Country:US
Mailing Address - Phone:214-755-7802
Mailing Address - Fax:817-237-4904
Practice Address - Street 1:2301 OLYMPIA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1844
Practice Address - Country:US
Practice Address - Phone:214-755-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional