Provider Demographics
NPI:1598946758
Name:CLEARE, TERRY P (MA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:P
Last Name:CLEARE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 69004
Mailing Address - Street 2:VAMC 116B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-9004
Mailing Address - Country:US
Mailing Address - Phone:318-474-0010
Mailing Address - Fax:318-483-5064
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:HIGHWAY 71
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306-9004
Practice Address - Country:US
Practice Address - Phone:318-474-0010
Practice Address - Fax:318-483-5064
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1372101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor