Provider Demographics
NPI:1780444190
Name:TERLAJE, JAMIE RAE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAE
Last Name:TERLAJE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 ROUTE 66 W STE 101
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-8322
Mailing Address - Country:US
Mailing Address - Phone:573-433-4846
Mailing Address - Fax:
Practice Address - Street 1:704 ROUTE 66 W STE 101
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-8322
Practice Address - Country:US
Practice Address - Phone:573-433-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health