Provider Demographics
NPI:1750779229
Name:LINS, TERRENCE J (SAC)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:J
Last Name:LINS
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2358
Mailing Address - Country:US
Mailing Address - Phone:608-649-8821
Mailing Address - Fax:
Practice Address - Street 1:221 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2358
Practice Address - Country:US
Practice Address - Phone:608-649-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15932-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)