Provider Demographics
NPI:1952884066
Name:GOLDSTEIN, TERRI ELISE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:ELISE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4797 S HUNTLY DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3780
Mailing Address - Country:US
Mailing Address - Phone:813-748-0898
Mailing Address - Fax:
Practice Address - Street 1:9192 S 300 W STE 23
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2673
Practice Address - Country:US
Practice Address - Phone:813-748-0898
Practice Address - Fax:435-775-2019
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10977755-6009101YM0800X
UT10977755-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health