Provider Demographics
NPI:1194873190
Name:ALLENDER, TERRI KELLY (MA)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:KELLY
Last Name:ALLENDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2021
Mailing Address - Country:US
Mailing Address - Phone:970-390-5708
Mailing Address - Fax:970-949-9276
Practice Address - Street 1:189 DAISY LANE
Practice Address - Street 2:
Practice Address - City:EAGLE-VAIL
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-390-5708
Practice Address - Fax:970-949-0276
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO112691Medicaid