Provider Demographics
NPI:1104259217
Name:TERRY, TEHRINA J (MC, LPC)
Entity type:Individual
Prefix:
First Name:TEHRINA
Middle Name:J
Last Name:TERRY
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 E BROADWAY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1737
Mailing Address - Country:US
Mailing Address - Phone:928-308-1171
Mailing Address - Fax:
Practice Address - Street 1:2131 E BROADWAY RD STE 9
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1737
Practice Address - Country:US
Practice Address - Phone:928-308-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLPC-15351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health