Provider Demographics
NPI:1144845389
Name:TERFRUCHTE, DEBRA DIANN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANN
Last Name:TERFRUCHTE
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 1:2001 WITHERS LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-9069
Mailing Address - Country:US
Mailing Address - Phone:309-826-9252
Mailing Address - Fax:
Practice Address - Street 1:2001 WITHERS LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-9069
Practice Address - Country:US
Practice Address - Phone:309-826-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0128491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.012849OtherLCSW LICENSE NUMBER