Provider Demographics
NPI:1497064273
Name:TERRELL, JOY LYNNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:LYNNETTE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 SUMMA AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3451
Mailing Address - Country:US
Mailing Address - Phone:225-678-6269
Mailing Address - Fax:225-454-6916
Practice Address - Street 1:8221 SUMMA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3451
Practice Address - Country:US
Practice Address - Phone:225-678-6269
Practice Address - Fax:225-454-6916
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1129103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2130374Medicaid