Provider Demographics
NPI:1902689268
Name:SLICK, TERRI JEAN (RBT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:JEAN
Last Name:SLICK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E RIDGEWAY DR APT 107
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2122
Mailing Address - Country:US
Mailing Address - Phone:785-545-5407
Mailing Address - Fax:
Practice Address - Street 1:2400 ELLIS ST STE 1
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3390
Practice Address - Country:US
Practice Address - Phone:682-877-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-177991106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician