Provider Demographics
NPI:1174573836
Name:TERRY, STEVEN G (MSW, LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:TERRY
Suffix:
Gender:M
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 E 31ST ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2452
Mailing Address - Country:US
Mailing Address - Phone:918-392-0336
Mailing Address - Fax:918-392-0337
Practice Address - Street 1:3223 E 31ST STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2452
Practice Address - Country:US
Practice Address - Phone:918-392-0336
Practice Address - Fax:918-392-0337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK01391041C0700X
OK141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4221760OtherAETNA PIN
OK513485291001OtherBCBS BILLING NUMBER