Provider Demographics
NPI:1528312311
Name:MARTIN, TERA LYNN (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W 1ST ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1307
Mailing Address - Country:US
Mailing Address - Phone:319-465-3727
Mailing Address - Fax:186-630-2433
Practice Address - Street 1:818 W 1ST ST
Practice Address - Street 2:STE 201
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1307
Practice Address - Country:US
Practice Address - Phone:319-465-3727
Practice Address - Fax:186-630-2433
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0080041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical