# MR. TERRY JOE BONEBRAKE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053051359
- **Gender:** Man
- **Credential:** CARE MANAGER/QIDP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 374J00000X | Doula | — | NULL | — |
| 374K00000X | Religious Nonmedical Practitioner | — | NULL | — |
| 374K00000X | Religious Nonmedical Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/01/2022
- **Last updated:** 04/01/2022