Basic Information
| Provider Information | |||||||||
| NPI: | 1780627372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIRER-BECKER | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMLP, LCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 747 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665050747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Practice Location | |||||||||
| Address1: | 814 CAROLINE AVE | ||||||||
| Address2: | |||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664415210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857625250 | ||||||||
| FaxNumber: | 7857622144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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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 | 101Y00000X | 0455 | KS | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 149 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 11759263 | 01 | KS | CAQH | OTHER | 070062 | 01 | KS | BCBS NUMBER | OTHER | 200438490A | 05 | KS | MEDICAID |