Provider Demographics
NPI:1396981098
Name:TERBRAK, DARLENE R (MS)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:R
Last Name:TERBRAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:R
Other - Last Name:HOLLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2585 COBDEN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COBDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62920-3433
Mailing Address - Country:US
Mailing Address - Phone:618-559-8583
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:618-658-2759
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health