Provider Demographics
NPI:1972659209
Name:TERRY, DEBRA C (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:C
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 SPEEDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5468
Mailing Address - Country:US
Mailing Address - Phone:406-543-0929
Mailing Address - Fax:
Practice Address - Street 1:2801 S RUSSELL ST
Practice Address - Street 2:SUITE 39
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7932
Practice Address - Country:US
Practice Address - Phone:406-543-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical