Provider Demographics
NPI:1881994176
Name:BREWER, TERRI ANN (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:ANN
Last Name:BREWER
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 30TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2409
Mailing Address - Country:US
Mailing Address - Phone:812-342-2615
Mailing Address - Fax:
Practice Address - Street 1:12000 W. MOORES VINEYARD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-342-2615
Practice Address - Fax:812-342-6811
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001658A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200258690AMedicaid
IN147270Medicare PIN