Provider Demographics
NPI:1699225250
Name:TERRELL, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
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 1:15751 LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1425
Mailing Address - Country:US
Mailing Address - Phone:313-346-2026
Mailing Address - Fax:
Practice Address - Street 1:15751 LAWTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1425
Practice Address - Country:US
Practice Address - Phone:313-346-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health