Provider Demographics
NPI:1669427761
Name:IMAR, TERRY RAMSEY (MA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:RAMSEY
Last Name:IMAR
Suffix:
Gender:M
Credentials:MA
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 1827
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1827
Mailing Address - Country:US
Mailing Address - Phone:740-369-3478
Mailing Address - Fax:740-881-0398
Practice Address - Street 1:244 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1317
Practice Address - Country:US
Practice Address - Phone:740-369-3478
Practice Address - Fax:740-881-0398
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1946103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289423Medicaid
OH219983OtherVALUEOPTIONS
OH0289423Medicaid