Provider Demographics
NPI:1598003295
Name:TERRY, JOAN BURGART (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:BURGART
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38073
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0073
Mailing Address - Country:US
Mailing Address - Phone:901-413-6446
Mailing Address - Fax:
Practice Address - Street 1:4646 POPLAR AVE
Practice Address - Street 2:SUITE 326
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4426
Practice Address - Country:US
Practice Address - Phone:901-413-6446
Practice Address - Fax:901-205-1971
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000042171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical