Provider Information for 1265426902
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MOLLY JEAN TERRY LMHC
Sex: Female
NPI: 1265426902
Last Updated: 2020-02-27
Certification Date: 2020-02-27
Certification Date: 2020-02-27
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265426902 | ||||||||
| Enumeration Date | 2005-09-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3023 US-19 ALT SUITE 102 PALM HARBOR, FL 34683 United States Phone: 727-254-9183 | Fax: | ||||||||
| Primary Practice Address | 3023 US-19 ALT SUITE 102 PALM HARBOR, FL 34683 United States Phone: 727-254-9183 | Fax: | ||||||||
| Secondary Practice Address(es) | 1975 W MAIN ST | ||||||||
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