Provider Demographics
NPI:1104969963
Name:FOLLETT, TERRY LEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LEE
Last Name:FOLLETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S PLUMOSA ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3567
Mailing Address - Country:US
Mailing Address - Phone:321-301-4591
Mailing Address - Fax:321-301-4589
Practice Address - Street 1:335 S PLUMOSA ST
Practice Address - Street 2:SUITE F
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3567
Practice Address - Country:US
Practice Address - Phone:321-301-4591
Practice Address - Fax:321-301-4589
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275850OtherWELLCARE
FLZ067ROtherBLUE CROSS BLUE SHIELD
FL572493OtherUNITED HEALTHCARE
FL591059517OtherTRICARE