Provider Demographics
NPI:1568443067
Name:FREERKS, TERRY VARNEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:VARNEY
Last Name:FREERKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4817
Mailing Address - Country:US
Mailing Address - Phone:314-918-7248
Mailing Address - Fax:314-918-7016
Practice Address - Street 1:7349 DALE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2241
Practice Address - Country:US
Practice Address - Phone:314-918-7248
Practice Address - Fax:314-918-7016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001497101YM0800X
MO300096106H00000X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist