1174838981 NPI number — TERRI DENISE GOSSETT NCC, LPC

Table of content: (NPI 1174124820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174838981 NPI number — TERRI DENISE GOSSETT NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSSETT
Provider First Name:
TERRI
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NCC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YELLE
Provider Other First Name:
TERRI
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174838981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3816 S. CLEAR CREEK RD.
Provider Second Line Business Mailing Address:
BUILDING C, STE. 301
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76549-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-824-8775
Provider Business Mailing Address Fax Number:
281-648-2200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3816 CLEAR CREEK RD, BUILDING C, STE. 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76549-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-824-8775
Provider Business Practice Location Address Fax Number:
281-648-2200
Provider Enumeration Date:
08/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  63217 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 63217 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)