MEDICARE: MR. TERRY F STULCE L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	000331	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	142924	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1922213115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY F STULCE L.C.S.W.

Provider Business Mailing Address
First Line	:	2775 EXECUTIVE PARK NW
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2723
Country	:	US
Telephone Number	:	423-479-9652
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 EXECUTIVE PARK NW
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2723
Country	:	US
Telephone Number	:	423-479-9652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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