Provider Demographics
NPI:1265415731
Name:TERRY, JOHN CARR (MS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARR
Last Name:TERRY
Suffix:
Gender:M
Credentials:MS
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 590
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0590
Mailing Address - Country:US
Mailing Address - Phone:304-431-3010
Mailing Address - Fax:304-431-3011
Practice Address - Street 1:2869 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963-5037
Practice Address - Country:US
Practice Address - Phone:304-431-3010
Practice Address - Fax:304-431-3011
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163306000Medicaid