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General NPI Number Information
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NPI Number | 1316201635
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Entity Type | Individual
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Provider Name | TERRI GWEN MENOTTI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 215 W MULBERRY ST STE.A
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City | DENTON
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State | TX
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Zip | 76201-6061
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Country | US
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Telephone | 940-367-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 439 SLAYDEN DR
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City | SUNSET
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State | TX
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Zip | 76270-2713
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Country | US
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Telephone | 940-367-1588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 23740
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 6191
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License Number State | TX
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