Provider Demographics
NPI:1679885461
Name:NANI, TERRY (NBCC, LPC, MED, MA)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:NANI
Suffix:
Gender:M
Credentials:NBCC, LPC, MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 EAGLE GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2148
Mailing Address - Country:US
Mailing Address - Phone:801-927-7322
Mailing Address - Fax:
Practice Address - Street 1:1700 EAGLE GLEN CIR
Practice Address - Street 2:
Practice Address - City:WEST BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84087-2148
Practice Address - Country:US
Practice Address - Phone:801-927-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70321396010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional