Provider Demographics
NPI:1851487128
Name:MCGUIRE, TERRENCE PATRICK (PSYD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:PATRICK
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 S 76TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:262-542-3255
Mailing Address - Fax:414-817-0442
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:414-817-0442
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1873-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39260700Medicaid