Provider Demographics
NPI:1619260460
Name:TERRELL, MARC AVERY (MED)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:AVERY
Last Name:TERRELL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MILL ST
Mailing Address - Street 2:#250
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1195
Mailing Address - Country:US
Mailing Address - Phone:775-688-1421
Mailing Address - Fax:775-688-2662
Practice Address - Street 1:560 MILL ST
Practice Address - Street 2:#250
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1195
Practice Address - Country:US
Practice Address - Phone:775-688-1421
Practice Address - Fax:775-688-2662
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor