Provider Demographics
NPI:1619199510
Name:TERRELL, STEPHEN J (PSYD, LPC, RPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PSYD, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CLAYTON LANE
Mailing Address - Street 2:SUITE 435-W
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-206-0260
Mailing Address - Fax:512-206-0030
Practice Address - Street 1:1106 CLAYTON LANE
Practice Address - Street 2:SUITE 435-W
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-206-0260
Practice Address - Fax:512-206-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional