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General NPI Number Information
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NPI Number | 1811204191
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Entity Type | Individual
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Provider Name | LARRY ALAN TERHERST MS, LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 1702 16TH AVE
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City | LEWISTON
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State | ID
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Zip | 83501-4023
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Country | US
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Telephone | 208-816-6979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1848
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City | LEWISTON
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State | ID
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Zip | 83501-1463
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Country | US
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Telephone | 208-816-6979
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-374
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License Number State | ID
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