Individual
TERRANCE SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3606 N 24TH ST, PHOENIX, AZ 85016-6509
(602) 980-1557
Mailing address
3606 N 24TH ST, PHOENIX, AZ 85016-6509
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-22538
AZ
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
06/30/2023
Last updated
04/19/2024
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