Provider Demographics
NPI:1356434542
Name:FOUTS, TERRY WAYNE (LSCSW)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
Last Name:FOUTS
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 STEDMAN ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6632
Mailing Address - Country:US
Mailing Address - Phone:907-225-7825
Mailing Address - Fax:907-225-1541
Practice Address - Street 1:721 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6632
Practice Address - Country:US
Practice Address - Phone:907-225-7825
Practice Address - Fax:907-225-1541
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1940104100000X
AK11471041C0700X
WALW60809671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1597OtherVALUE OPTION INC
KS201597OtherGREAT WEST HEALTH PARTNER
KS066882OtherBLUE CROSS BLUE SHIELD
AKMH3260Medicaid
KS201597OtherGREAT WEST HEALTH PARTNER