Provider Demographics
NPI:1124665658
Name:SKAGGS, TERRANCE THOMAS
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:THOMAS
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 STEARNS WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1275
Mailing Address - Country:US
Mailing Address - Phone:320-253-3540
Mailing Address - Fax:
Practice Address - Street 1:2025 STEARNS WAY STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1275
Practice Address - Country:US
Practice Address - Phone:320-253-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist