Provider Demographics
NPI:1518018381
Name:TERRILL, WILMA I (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:I
Last Name:TERRILL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13793 RACCOON MTN.RD.
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-1034
Mailing Address - Fax:
Practice Address - Street 1:103 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 104 A
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2941
Practice Address - Country:US
Practice Address - Phone:530-265-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist