Provider Demographics
NPI:1457602500
Name:GAUSE, TERRILYNNE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:TERRILYNNE
Middle Name:
Last Name:GAUSE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MISS
Other - First Name:TERRILYNNE
Other - Middle Name:
Other - Last Name:GAUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:4321 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-1720
Mailing Address - Country:US
Mailing Address - Phone:313-369-1717
Mailing Address - Fax:313-369-1728
Practice Address - Street 1:4321 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1720
Practice Address - Country:US
Practice Address - Phone:313-369-1717
Practice Address - Fax:313-369-1728
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical