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General NPI Number Information
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NPI Number | 1497079982
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Entity Type | Individual
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Provider Name | TERA DEE NANCE MS, NCC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 101 W. KIRKWOOD AVENUE SUITE 009 FOUNTAIN SQUARE MALL
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone | 812-272-0934
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Fax | 812-339-2799
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Provider Business Mailing Address
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Address Line | 101 W. KIRKWOOD AVENUE SUITE 009 FOUNTAIN SQUARE MALL
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone | 812-272-0934
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Fax | 812-339-2799
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39002092A
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License Number State | IN
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