MEDICARE: TEDDY TERHUNE

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	69615	TX
2	101YM0800X	Mental Health Counselor	69615	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004FR	OTHER		BLUECROSS BLUESHIELD OF TEXAS

General Provider Information

NPI Number	:	1255712139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEDDY TERHUNE

Provider Business Mailing Address
First Line	:	5304A WOODROW AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2107
Country	:	US
Telephone Number	:	512-586-8118
Fax Number	:	512-672-6166

Provider Business Practice Location Address
First Line	:	5304A WOODROW AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2107
Country	:	US
Telephone Number	:	512-586-8118
Fax Number	:	512-672-6166

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	09/22/2018

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Directions to “ TEDDY TERHUNE ” Practice Location

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