Provider Demographics
NPI:1013102102
Name:MASTERS, TERRY DOUGLAS (MSW-LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DOUGLAS
Last Name:MASTERS
Suffix:
Gender:M
Credentials:MSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3103
Mailing Address - Country:US
Mailing Address - Phone:405-943-9143
Mailing Address - Fax:
Practice Address - Street 1:2853 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-3103
Practice Address - Country:US
Practice Address - Phone:405-943-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical