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NPI Code Detail

MEDICARE: ANDREA WALLACE-TERWILLIGER T-LMHC

MEDICARE: ANDREA WALLACE-TERWILLIGER T-LMHC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114607793
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA WALLACE-TERWILLIGER T-LMHC
Provider Business Mailing Address
First Line : PO BOX 115
Second Line :
City : SHENANDOAH
State : IA
Zip : 51601-0115
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1977 G AVE
Second Line :
City : RED OAK
State : IA
Zip : 51566-4474
Country : US
Telephone Number : 712-623-6349
Fax Number : 712-623-6047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2023
Last Update Date : 01/12/2026

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