Provider Demographics
NPI:1780820357
Name:SLACK, TERRI TARRANT (LADC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:TARRANT
Last Name:SLACK
Suffix:
Gender:F
Credentials:LADC, LPC
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LADC
Mailing Address - Street 1:1741 W 33RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3838
Mailing Address - Country:US
Mailing Address - Phone:405-401-1464
Mailing Address - Fax:
Practice Address - Street 1:1741 W 33RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3837
Practice Address - Country:US
Practice Address - Phone:405-401-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK638101YA0400X
OK4164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional