Provider Demographics
NPI:1134104359
Name:WOLF, TERRY (LPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9065
Mailing Address - Country:US
Mailing Address - Phone:417-781-7706
Mailing Address - Fax:417-781-7706
Practice Address - Street 1:2401 N MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9065
Practice Address - Country:US
Practice Address - Phone:417-781-7706
Practice Address - Fax:417-781-7706
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional