Provider Demographics
NPI:1457161267
Name:DEMIEN, TERRA GENE
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:GENE
Last Name:DEMIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 CHATEAU KNLS
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3427
Mailing Address - Country:US
Mailing Address - Phone:970-361-5245
Mailing Address - Fax:
Practice Address - Street 1:3625 UTICA RIDGE RD STE F
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1653
Practice Address - Country:US
Practice Address - Phone:563-484-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health