Provider Demographics
NPI:1922307602
Name:MARR, TERRALYN
Entity Type:Individual
Prefix:
First Name:TERRALYN
Middle Name:
Last Name:MARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 WIZARD WAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1347
Mailing Address - Country:US
Mailing Address - Phone:702-574-8698
Mailing Address - Fax:
Practice Address - Street 1:5709 WIZARD WAND ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1347
Practice Address - Country:US
Practice Address - Phone:702-574-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst