Provider Demographics
NPI:1194083212
Name:TERRI MUDGE, LPC, INC.
Entity type:Organization
Organization Name:TERRI MUDGE, LPC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:MUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:251-343-2597
Mailing Address - Street 1:5905 AIRPORT BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5905 AIRPORT BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3168
Practice Address - Country:US
Practice Address - Phone:251-343-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty