Provider Demographics
NPI:1952380693
Name:TERRY, PAMELA B (LMHC CRC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:TERRY
Suffix:
Gender:F
Credentials:LMHC CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 IOWA AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3837
Mailing Address - Country:US
Mailing Address - Phone:563-263-5170
Mailing Address - Fax:563-288-6503
Practice Address - Street 1:315 IOWA AVE
Practice Address - Street 2:STE C
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3837
Practice Address - Country:US
Practice Address - Phone:563-263-5170
Practice Address - Fax:563-288-6503
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA247591OtherMIDLAND'S CHOICE