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NPI Code Detail

MEDICARE: MS. ANDREA TERRY LPCC

MEDICARE: MS. ANDREA TERRY LPCC
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
1101YP2500XProfessional Counselor0086301NM

General Provider Information

NPI Number : 1750347951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANDREA TERRY LPCC
Provider Business Mailing Address
First Line : PO BOX 241
Second Line :
City : EL PRADO
State : NM
Zip : 87529
Country : US
Telephone Number : 505-613-3221
Fax Number :
Provider Business Practice Location Address
First Line : 6 SACRED VISTA
Second Line :
City : EL PRADO
State : NM
Zip : 87529
Country : US
Telephone Number : 575-613-3221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 08/31/2011

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