Provider Demographics
NPI:1952348344
Name:DEVRIES, TERRY BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:BETH
Last Name:DEVRIES
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 1:25964 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:CA
Mailing Address - Zip Code:95666-9479
Mailing Address - Country:US
Mailing Address - Phone:209-295-4133
Mailing Address - Fax:209-267-9872
Practice Address - Street 1:16 BRYSON DR
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4118
Practice Address - Country:US
Practice Address - Phone:209-267-9801
Practice Address - Fax:209-267-9801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS135771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS13577OtherLICENSE NUMBER, CALIF.