Provider Demographics
NPI:1982214292
Name:ROBBINS, TERA DEE (MSW)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:DEE
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 VILLAGE WEST PL APT B
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4517
Mailing Address - Country:US
Mailing Address - Phone:918-839-4917
Mailing Address - Fax:
Practice Address - Street 1:1002 CAMBELL STREET
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469
Practice Address - Country:US
Practice Address - Phone:918-463-2581
Practice Address - Fax:918-463-2585
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7492-P101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor