Provider Demographics
NPI:1922014919
Name:STERRY, TERRY W (PH D)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:STERRY
Suffix:
Gender:M
Credentials:PH D
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 141131
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45250-1131
Mailing Address - Country:US
Mailing Address - Phone:513-481-7500
Mailing Address - Fax:
Practice Address - Street 1:3345 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6543
Practice Address - Country:US
Practice Address - Phone:513-481-7500
Practice Address - Fax:513-481-6316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1366103TC0700X
OH6295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical