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NPI Code Detail

MEDICARE: TERRIS MIKE

MEDICARE: TERRIS MIKE
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
1104100000XSocial Worker
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205200557
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRIS MIKE
Provider Business Mailing Address
First Line : 2924 KNIGHT ST
Second Line : #434
City : SHREVEPORT
State : LA
Zip : 71105-2415
Country : US
Telephone Number : 318-631-1122
Fax Number :
Provider Business Practice Location Address
First Line : 2219 CLAIBORNE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4301
Country : US
Telephone Number : 318-779-0434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2015
Last Update Date : 05/29/2019

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Directions to “ TERRIS MIKE ” Practice Location

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