MEDICARE: TERI MUSIC MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619294964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI MUSIC MS

Provider Business Mailing Address
First Line	:	400 N STATE ST # 4
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-5121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N STATE ST # 4
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-5121
Country	:	US
Telephone Number	:	580-774-2229
Fax Number	:

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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Directions to “ TERI MUSIC MS” Practice Location

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