Provider Demographics
NPI:1881556827
Name:LOUDERMILK, TERENISHA DESHON ALEXANDRIA
Entity type:Individual
Prefix:
First Name:TERENISHA
Middle Name:DESHON ALEXANDRIA
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-1821
Mailing Address - Country:US
Mailing Address - Phone:870-690-7740
Mailing Address - Fax:
Practice Address - Street 1:2540 HWY 388
Practice Address - Street 2:
Practice Address - City:GOULD
Practice Address - State:AR
Practice Address - Zip Code:71643
Practice Address - Country:US
Practice Address - Phone:870-850-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-28
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty