Provider Demographics
NPI:1568633261
Name:PAGE, TERRY LAROYCE
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LAROYCE
Last Name:PAGE
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 1:8390 DELMAR BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2117
Mailing Address - Country:US
Mailing Address - Phone:314-692-9010
Mailing Address - Fax:314-692-9014
Practice Address - Street 1:8390 DELMAR BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2117
Practice Address - Country:US
Practice Address - Phone:314-692-9010
Practice Address - Fax:314-692-9014
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical