Provider Demographics
NPI:1467504522
Name:WALDREN, TERRY E (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:E
Last Name:WALDREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1629
Mailing Address - Country:US
Mailing Address - Phone:806-762-6348
Mailing Address - Fax:806-762-1173
Practice Address - Street 1:2507 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1629
Practice Address - Country:US
Practice Address - Phone:806-762-6348
Practice Address - Fax:806-762-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1591101YP2500X
TX1824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional