MEDICARE: TERRICA HENRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1114470978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRICA HENRY

Provider Business Mailing Address
First Line	:	7709 WYNGATE BLVD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-3927
Country	:	US
Telephone Number	:	318-617-3329
Fax Number	:

Provider Business Practice Location Address
First Line	:	7709 WYNGATE BLVD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-3927
Country	:	US
Telephone Number	:	318-617-3329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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Directions to “ TERRICA HENRY ” Practice Location

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