Provider Demographics
NPI:1144952136
Name:PRITCHETT, TERRY STEPHEN (LPC-IT)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:STEPHEN
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3939
Mailing Address - Country:US
Mailing Address - Phone:262-728-2774
Mailing Address - Fax:
Practice Address - Street 1:647 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1990
Practice Address - Country:US
Practice Address - Phone:262-441-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4329-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional