Healthcare Provider Details

I. General information

NPI: 1265584841
Provider Name (Legal Business Name): FRED TERBUSH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

10368 RENE DR
CLIO MI
48420-1982
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3740
  • Fax:
Mailing address:
  • Phone: 810-687-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061044
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: