Individual
TERRY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW
Contact information
Practice address
901 HIGHWAY 80 E, CLINTON, MS 39056-5244
(601) 927-0188
Mailing address
PO BOX 2305, CLINTON, MS 39060-2305
(601) 927-0188
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02551264
—
MS
Enumeration date
07/16/2020
Last updated
07/16/2020
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