Healthcare Provider Details

I. General information

NPI: 1265415731
Provider Name (Legal Business Name): JOHN CARR TERRY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 12TH STREET EXT
PRINCETON WV
24740-2329
US

IV. Provider business mailing address

200 12TH STREET EXT
PRINCETON WV
24740-2329
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-9541
  • Fax:
Mailing address:
  • Phone: 304-425-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number468
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: