Provider Demographics
NPI:1831761576
Name:BOR, TERYN MALYNNE (LMSW)
Entity type:Individual
Prefix:
First Name:TERYN
Middle Name:MALYNNE
Last Name:BOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TERYN
Other - Middle Name:MALYNNE
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:1278 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-9612
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:816-633-7942
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11543104100000X
MO2020038948104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker