Provider Demographics
NPI:1922531342
Name:TERRELL, LEONETTA
Entity Type:Individual
Prefix:
First Name:LEONETTA
Middle Name:
Last Name:TERRELL
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 1:1830 SAINT BERNARD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1329
Mailing Address - Country:US
Mailing Address - Phone:504-603-2389
Mailing Address - Fax:
Practice Address - Street 1:1830 SAINT BERNARD AVE STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1329
Practice Address - Country:US
Practice Address - Phone:504-603-2389
Practice Address - Fax:504-609-3366
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health