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General NPI Number Information
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NPI Number | 1053779421
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Entity Type | Organization
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Legal Business Name | TERRI SQUIRES, LPC, FNP-C, PNP-C, APRN-RX
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 560 MOUNTAIN VILLAGE BLVD # 102A-B SUITE 102A-B
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City | TELLURIDE
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State | CO
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Zip | 81435-9513
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Country | US
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Telephone | 808-866-6533
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Fax | 888-338-7728
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Provider Business Mailing Address
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Address Line | PO BOX 3629
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City | TELLURIDE
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State | CO
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Zip | 81435-3629
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Country | US
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Telephone | 808-866-6533
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Fax | 888-338-7728
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Authorized Official
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Title or Position | CEO
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Name | PROF. TERRI LEIGH SQUIRES
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Credential | LPC, FNP-C, PNP-C,
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Telephone | 808-866-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5346
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License Number State | CO
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