Provider Demographics
NPI:1700208428
Name:OURS, TERRA
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:OURS
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 1:811 E FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711
Mailing Address - Country:US
Mailing Address - Phone:317-686-5800
Mailing Address - Fax:
Practice Address - Street 1:811 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5623
Practice Address - Country:US
Practice Address - Phone:812-423-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006582A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical