Provider Demographics
NPI:1194737957
Name:JASON, TERRY (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:JASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:JASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3920 S MILTON DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4044
Mailing Address - Country:US
Mailing Address - Phone:816-373-4668
Mailing Address - Fax:
Practice Address - Street 1:7900 LEES SUMMIT RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64139-1236
Practice Address - Country:US
Practice Address - Phone:816-404-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001562631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical