Provider Demographics
NPI:1528525037
Name:TERRI EIDEM COUNSELING LLC
Entity type:Organization
Organization Name:TERRI EIDEM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDEM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-749-7358
Mailing Address - Street 1:124 RIVER LAKES LN
Mailing Address - Street 2:
Mailing Address - City:MARTINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78655-3907
Mailing Address - Country:US
Mailing Address - Phone:512-749-7358
Mailing Address - Fax:
Practice Address - Street 1:2020 FM 967
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2877
Practice Address - Country:US
Practice Address - Phone:512-523-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty