Provider Demographics
NPI:1407148364
Name:SHIRLEY, TERRY LYNN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1112 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7707
Mailing Address - Country:US
Mailing Address - Phone:573-334-5513
Mailing Address - Fax:573-334-0312
Practice Address - Street 1:1112 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7707
Practice Address - Country:US
Practice Address - Phone:573-334-5513
Practice Address - Fax:573-334-0312
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130337361041C0700X
MI68011156441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1407148364OtherNPI