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General NPI Number Information
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NPI Number | 1457844953
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Entity Type | Organization
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Legal Business Name | TERRA THERAPIES, PLLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 1706 ENDERLY PL
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City | FORT WORTH
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State | TX
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Zip | 76104-4122
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Country | US
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Telephone | 817-907-0022
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Fax | 817-945-1456
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Provider Business Mailing Address
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Address Line | 4113 MARKS PL
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City | FORT WORTH
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State | TX
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Zip | 76116-7900
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Country | US
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Telephone | 817-907-0022
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Fax | 817-945-1456
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | COURTNEY J GUHL
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Credential | LPC
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Telephone | 817-907-0022
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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 | 66955
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License Number State | TX
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