MEDICARE: DR. TERRI SKINNER CHADWICK PHD

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	103TC1900X	Counseling Psychologist	24915	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902816036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRI SKINNER CHADWICK PHD

Provider Business Mailing Address
First Line	:	219 E LOCUST ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3955
Country	:	US
Telephone Number	:	210-333-4755
Fax Number	:	210-333-1833

Provider Business Practice Location Address
First Line	:	2611 EISENHAUER RD APT 1007
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3470
Country	:	US
Telephone Number	:	210-332-0032
Fax Number	:	210-333-1833

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/05/2016

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