Basic Information
| Provider Information | |||||||||
| NPI: | 1255514477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMARS | ||||||||
| FirstName: | TERRENCE | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | MERITCARE NORTHWEST MEDICAL CENTER | ||||||||
| Address2: | P.O BOX 531 | ||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814240 | ||||||||
| FaxNumber: | 2186834512 | ||||||||
| Practice Location | |||||||||
| Address1: | MERITCARE NORTHWEST MEDICAL CENTER | ||||||||
| Address2: | 120 LABREE AVE S | ||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814240 | ||||||||
| FaxNumber: | 2186834512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 12/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10255 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.