Healthcare Provider Details

I. General information

NPI: 1811994312
Provider Name (Legal Business Name): TERRY OJURE L.P.C. & LSATP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S RANDOLPH ST
LEXINGTON VA
24450-2366
US

IV. Provider business mailing address

163 WINEBERRY LN
LEXINGTON VA
24450-7034
US

V. Phone/Fax

Practice location:
  • Phone: 540-817-4063
  • Fax: 540-463-2635
Mailing address:
  • Phone: 540-817-4063
  • Fax: 540-463-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000018
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701001662
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: