MEDICARE: TERA GURNEY MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149019383	IL

General Provider Information

NPI Number	:	1225772718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERA GURNEY MSW

Provider Business Mailing Address
First Line	:	PO BOX 752123
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77275-2123
Country	:	US
Telephone Number	:	312-476-9064
Fax Number	:	312-900-8230

Provider Business Practice Location Address
First Line	:	1448 N MILWAUKEE AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-6412
Country	:	US
Telephone Number	:	312-476-9064
Fax Number	:	312-900-8230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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