Provider Demographics
NPI:1477326726
Name:TERRELL, WHITLEY TAYLER (LPC)
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:TAYLER
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 N WASHINGTON ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1462
Mailing Address - Country:US
Mailing Address - Phone:630-995-3193
Mailing Address - Fax:
Practice Address - Street 1:620 W ROOSEVELT RD STE C1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2306
Practice Address - Country:US
Practice Address - Phone:630-995-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019494101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor