Provider Demographics
NPI:1912474636
Name:TERRY, JOLENE (LPC)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:TERRY
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 1:1034 EARLY BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2252
Mailing Address - Country:US
Mailing Address - Phone:325-998-3683
Mailing Address - Fax:
Practice Address - Street 1:1034 EARLY BLVD APT 6
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2252
Practice Address - Country:US
Practice Address - Phone:325-998-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional