Provider Demographics
NPI:1316924350
Name:PETTY, TERRI L (LPC)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:PETTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6478
Mailing Address - Country:US
Mailing Address - Phone:501-624-7111
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:125 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-624-7111
Practice Address - Fax:501-620-5109
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9807015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid
AR222090OtherUNITED BEHAVIORAL HEALTH
AR5X327OtherBLUE CROSS/BLUE SHIELD
AR2159301OtherCIGNA BEHAVIORAL HEALTH
AR3070018000OtherQUAL-CHOICE
AR3509001000OtherMAGELLAN
AR216631OtherMHN NETWORK
AR60054OtherAETNA
AR71-0401764OtherCORPHEALTH
AR562340OtherVALUE OPTIONS