Provider Demographics
NPI:1700136991
Name:STAFFORD, TERRI ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:ALLISON
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7472 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2220
Mailing Address - Country:US
Mailing Address - Phone:323-229-8993
Mailing Address - Fax:314-962-0652
Practice Address - Street 1:1750 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1315
Practice Address - Country:US
Practice Address - Phone:323-229-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080241371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical