Provider Demographics
NPI:1205905189
Name:TERRELL, BILLIE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6169
Mailing Address - Country:US
Mailing Address - Phone:815-740-3460
Mailing Address - Fax:815-740-4243
Practice Address - Street 1:311 N OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4048
Practice Address - Country:US
Practice Address - Phone:877-613-9393
Practice Address - Fax:815-740-4243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical