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NPI Code Detail

MEDICARE: MRS. AMANDA LYNN TERRY LMFT

MEDICARE:  MRS. AMANDA LYNN TERRY  LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT 1003LA

General Provider Information

NPI Number : 1033390364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA LYNN TERRY LMFT
Provider Business Mailing Address
First Line : 7200 DESIARD ST
Second Line :
City : MONROE
State : LA
Zip : 71203-3913
Country : US
Telephone Number : 318-345-8200
Fax Number : 318-342-8049
Provider Business Practice Location Address
First Line : 7200 DESIARD ST
Second Line :
City : MONROE
State : LA
Zip : 71203-3913
Country : US
Telephone Number : 318-345-8200
Fax Number : 318-342-8049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 11/15/2007

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Directions to “ MRS. AMANDA LYNN TERRY LMFT” Practice Location

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