MEDICARE: TERRA TUONO-SHELL 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	LC3111	MD

General Provider Information

NPI Number	:	1699070078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRA TUONO-SHELL LCPC

Provider Business Mailing Address
First Line	:	5500 MING AVE STE 265
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-4689
Country	:	US
Telephone Number	:	240-274-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	7945 MACARTHUR BLVD STE 214
Second Line	:
City	:	CABIN JOHN
State	:	MD
Zip	:	20818-1634
Country	:	US
Telephone Number	:	240-274-7496
Fax Number	:

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

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	03/30/2021

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