Healthcare Provider Details

I. General information

NPI: 1851487128
Provider Name (Legal Business Name): TERRENCE PATRICK MCGUIRE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 S 76TH ST SUITE 208
GREENFIELD WI
53220-4364
US

IV. Provider business mailing address

4811 S 76TH ST SUITE 208
GREENFIELD WI
53220-4364
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3255
  • Fax: 414-817-0442
Mailing address:
  • Phone: 262-542-3255
  • Fax: 414-817-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1873-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: