Provider Demographics
NPI:1881147171
Name:TERRAL, ILONA (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:TERRAL
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:ILONA
Other - Middle Name:
Other - Last Name:GUNCHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 WILLIAMS ENTERPRISE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4280
Mailing Address - Country:US
Mailing Address - Phone:931-528-9222
Mailing Address - Fax:
Practice Address - Street 1:3300 WILLIAMS ENTERPRISE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4280
Practice Address - Country:US
Practice Address - Phone:931-528-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003540101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health