MEDICARE: MR. SCOTT JON TERRES LPC

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
1	101YP2500X	Professional Counselor	61372	TX

General Provider Information

NPI Number	:	1689854168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT JON TERRES LPC

Provider Business Mailing Address
First Line	:	8500 N MOPAC EXPY
Second Line	:	SUITE 820
City	:	AUSTIN
State	:	TX
Zip	:	78759-8375
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N MOPAC EXPY
Second Line	:	SUITE 820
City	:	AUSTIN
State	:	TX
Zip	:	78759-8375
Country	:	US
Telephone Number	:	512-671-9945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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