Provider Demographics
NPI:1689307936
Name:TERRELL, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:TERRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WOODLAWN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4332
Mailing Address - Country:US
Mailing Address - Phone:316-202-5463
Mailing Address - Fax:
Practice Address - Street 1:400 N WOODLAWN ST STE 214
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4332
Practice Address - Country:US
Practice Address - Phone:316-202-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker