Provider Demographics
NPI:1114099751
Name:ORDAHL, TERRI (PSY D)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:ORDAHL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11247 GLENN LN
Mailing Address - Street 2:
Mailing Address - City:SCURRY
Mailing Address - State:TX
Mailing Address - Zip Code:75158-3707
Mailing Address - Country:US
Mailing Address - Phone:903-340-9915
Mailing Address - Fax:
Practice Address - Street 1:102 E MOORE AVE STE 225
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3244
Practice Address - Country:US
Practice Address - Phone:903-340-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
680002135Medicare ID - Type Unspecified
MN846919900Medicaid