MEDICARE: KAREN M TERRY PHD PSYCHOLOGICAL SRV

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	103TC0700X	Clinical Psychologist	4563	OH

General Provider Information

NPI Number	:	1942489505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN M TERRY PHD PSYCHOLOGICAL SRV

Provider Business Mailing Address
First Line	:	5979 E LIVINGSTON AVE
Second Line	:	SUITE 101
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2908
Country	:	US
Telephone Number	:	614-860-0580
Fax Number	:	614-860-0595

Provider Business Practice Location Address
First Line	:	5979 E LIVINGSTON AVE
Second Line	:	SUITE 101
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2908
Country	:	US
Telephone Number	:	614-860-0580
Fax Number	:	614-860-0595

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. KAREN MICHELLE TERRY
Credential	:	PH.D.
Telephone Number	:	614-860-0580

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	06/01/2016

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