Basic Information
| Provider Information | |||||||||
| NPI: | 1992017578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNAUF | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | GSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 INDUSTRIAL DR | ||||||||
| Address2: | |||||||||
| City: | OBERLIN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706553519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3376393001 | ||||||||
| FaxNumber: | 3376393008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 COMMON ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706015255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374374014 | ||||||||
| FaxNumber: | 3376393008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10113 | LA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.