Basic Information
| Provider Information | |||||||||
| NPI: | 1578933958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURSEY | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4104 FORSYTHE AVE | ||||||||
| Address2: | NONE | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712012207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184500550 | ||||||||
| FaxNumber: | 3184101065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184101062 | ||||||||
| FaxNumber: | 3184101065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5391 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.