Healthcare Provider Details

I. General information

NPI: 1518762632
Provider Name (Legal Business Name): TERRI LYNN BUBNAR LPC-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

IV. Provider business mailing address

1195 LEHIGH DR
MORGANTOWN WV
26508-6401
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-1731
  • Fax:
Mailing address:
  • Phone: 907-947-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number966
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: