Provider Demographics
NPI:1306912092
Name:BELLAS, TERRI A (LCPC)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:A
Last Name:BELLAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GORHAM RD
Mailing Address - Street 2:BOX 265
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-4000
Mailing Address - Country:US
Mailing Address - Phone:207-415-0626
Mailing Address - Fax:
Practice Address - Street 1:31 GORHAM RD.
Practice Address - Street 2:BOX 265
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04070-4007
Practice Address - Country:US
Practice Address - Phone:207-415-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431984599Medicaid