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General NPI Number Information
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NPI Number | 1104186162
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Entity Type | Organization
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Legal Business Name | TERRY AULTMAN LPC, P.C.
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 6232 N HIGHWAY 146 SUITE 104
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City | BAYTOWN
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State | TX
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Zip | 77523-9081
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Country | US
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Telephone | 281-918-0152
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Fax | 281-918-0151
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Provider Business Mailing Address
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Address Line | 6232 N HIGHWAY 146 SUITE 104
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City | BAYTOWN
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State | TX
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Zip | 77523-9081
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Country | US
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Telephone | 281-918-0152
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Fax | 281-918-0151
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Authorized Official
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Title or Position | PRESIDENT / THERAPIST
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Name | TERRY THOMAS AULTMAN
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Credential | LPC
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Telephone | 281-918-0152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61145
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License Number State | TX
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