Provider Demographics
NPI:1730255704
Name:MUDGE, TERRI CASEY (LPC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:CASEY
Last Name:MUDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 AIRPORT BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3168
Mailing Address - Country:US
Mailing Address - Phone:251-343-2597
Mailing Address - Fax:251-343-0122
Practice Address - Street 1:5905 AIRPORT BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3168
Practice Address - Country:US
Practice Address - Phone:251-343-2597
Practice Address - Fax:251-343-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527453OtherBCBS