MEDICARE: ILONA TERRAL LPC-MHSP

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	101YM0800X	Mental Health Counselor	LPC0000003540	TN
2	101YP2500X	Professional Counselor	LPC0000003540	TN

General Provider Information

NPI Number	:	1881147171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILONA TERRAL LPC-MHSP

Provider Business Mailing Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:	SUITE 1
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4280
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:	SUITE 1
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4280
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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Directions to “ ILONA TERRAL LPC-MHSP” Practice Location

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