Provider Demographics
NPI:1629598107
Name:TERRELL, TAHKYRA TANAY (LPCC)
Entity Type:Individual
Prefix:
First Name:TAHKYRA
Middle Name:TANAY
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3706
Mailing Address - Country:US
Mailing Address - Phone:419-528-5993
Mailing Address - Fax:567-560-5486
Practice Address - Street 1:680 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3706
Practice Address - Country:US
Practice Address - Phone:419-528-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health