Doctor Name: | MR. TERRY LEE MASHBURN |
NPI Number: | 1033366117 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | MH7976 |
Business Practice Address: | 128 N Chalkville Rd Trussville, AL - 351731373 |
Business Phone Number: | 2052762419 |
Business Fax Number: | 2056553851 |
Mailing Address: | 128 N Chalkville Rd, TRUSSVILLE |
State: | AL |
Postal Code: | 351731373 |
Phone Number: | 2052762419 |
Fax Number: | 2056553851 |
NPI Enumeration Date: | 08/20/2008 |
NPI Last Update Date: | 08/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7976 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |