MEDICARE: KIM TERRY, LCPC

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	101YP2500X	Professional Counselor	CP0007	NV

General Provider Information

NPI Number	:	1215293543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM TERRY, LCPC

Provider Business Mailing Address
First Line	:	7918 GRANITE WALK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8218
Country	:	US
Telephone Number	:	478-951-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	6284 S RAINBOW BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3245
Country	:	US
Telephone Number	:	702-257-0140
Fax Number	:

Authorized Official
Title or Position	:	LCPC
Name	:	KIM ELIZABETH TERRY
Credential	:	MAHS, LCPC, LPC
Telephone Number	:	702-257-0140

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/11/2012

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