Basic Information
| Provider Information | |||||||||
| NPI: | 1114212651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUNEWALD | ||||||||
| FirstName: | TERRICA | ||||||||
| MiddleName: | DUNCAN | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 CHISHOLM TRL | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730962342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807741221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 N 31ST ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736019116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803236021 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 06/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 674 | OK | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.