Provider Demographics
NPI:1689849234
Name:BLANTON, TERRY G (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:G
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4557
Mailing Address - Country:US
Mailing Address - Phone:636-925-0152
Mailing Address - Fax:
Practice Address - Street 1:2977 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4557
Practice Address - Country:US
Practice Address - Phone:636-925-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080106251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical