Healthcare Provider Details

I. General information

NPI: 1619214566
Provider Name (Legal Business Name): DANIEL SCOTT TERRY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2013
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 401
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 314-327-7573
  • Fax:
Mailing address:
  • Phone: 314-327-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009024322
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: