Provider Demographics
NPI:1336760651
Name:TINGLE, TERRIE G (LCDC)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:G
Last Name:TINGLE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 FONDREN RD STE 376
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4661
Mailing Address - Country:US
Mailing Address - Phone:713-728-8287
Mailing Address - Fax:
Practice Address - Street 1:10103 FONDREN RD STE 376
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4661
Practice Address - Country:US
Practice Address - Phone:713-728-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14068171M00000X, 251B00000X, 405300000X, 101YA0400X
TX5381172V00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No405300000XOther Service ProvidersPrevention Professional