Provider Demographics
NPI:1215211859
Name:MURRELL, THERESA L
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:MURRELL
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 1:6711 KENWELL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5345
Mailing Address - Country:US
Mailing Address - Phone:214-906-9201
Mailing Address - Fax:
Practice Address - Street 1:4222 ROSEHILL RD
Practice Address - Street 2:SUITE 10
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2503
Practice Address - Country:US
Practice Address - Phone:972-271-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
TX111949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist