Provider Demographics
NPI:1366106221
Name:SIMECK, TERRI L (LCSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:SIMECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 E NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7447
Mailing Address - Country:US
Mailing Address - Phone:907-841-0769
Mailing Address - Fax:
Practice Address - Street 1:865 N SEWARD MERIDIAN PKWY STE 105
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7241
Practice Address - Country:US
Practice Address - Phone:907-631-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSWS9261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical