Healthcare Provider Details

I. General information

NPI: 1811930993
Provider Name (Legal Business Name): TERRY PFANNENSTIEL LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CLAFLIN RD
MANHATTAN KS
66502-3415
US

IV. Provider business mailing address

PO BOX 747
MANHATTAN KS
66505-0747
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-4300
  • Fax: 785-587-4305
Mailing address:
  • Phone: 785-587-4300
  • Fax: 785-587-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0110
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number326
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number015
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number326
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0110
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: