Provider Demographics
NPI:1255514477
Name:DEMARS, TERRENCE ROBERT (LICSW)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:ROBERT
Last Name:DEMARS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MERITCARE NORTHWEST MEDICAL CENTER
Mailing Address - Street 2:P.O BOX 531
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701
Mailing Address - Country:US
Mailing Address - Phone:218-681-4240
Mailing Address - Fax:218-683-4512
Practice Address - Street 1:MERITCARE NORTHWEST MEDICAL CENTER
Practice Address - Street 2:120 LABREE AVE S
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701
Practice Address - Country:US
Practice Address - Phone:218-681-4240
Practice Address - Fax:218-683-4512
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical