1174838981 NPI number — TERRI DENISE GOSSETT LPC

Table of content: TERRI DENISE GOSSETT LPC (NPI 1174838981)

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 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:
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:
08/08/2023
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: 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)