Provider Demographics
NPI:1497079982
Name:NANCE, TERA DEE (MS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:DEE
Last Name:NANCE
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W. KIRKWOOD AVENUE
Mailing Address - Street 2:SUITE 009 FOUNTAIN SQUARE MALL
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404
Mailing Address - Country:US
Mailing Address - Phone:812-272-0934
Mailing Address - Fax:812-339-2799
Practice Address - Street 1:101 W. KIRKWOOD AVENUE
Practice Address - Street 2:SUITE 009 FOUNTAIN SQUARE MALL
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-272-0934
Practice Address - Fax:812-339-2799
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002092A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health