Provider Demographics
NPI:1215293543
Name:KIM TERRY, LCPC
Entity type:Organization
Organization Name:KIM TERRY, LCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MAHS, LCPC, LPC
Authorized Official - Phone:702-257-0140
Mailing Address - Street 1:7918 GRANITE WALK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8218
Mailing Address - Country:US
Mailing Address - Phone:478-951-0522
Mailing Address - Fax:
Practice Address - Street 1:6284 S RAINBOW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3245
Practice Address - Country:US
Practice Address - Phone:702-257-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty