Provider Demographics
NPI:1831424852
Name:SELL, TERALYN ANNE (LPC, CSAC, CSC-IT,)
Entity type:Individual
Prefix:MRS
First Name:TERALYN
Middle Name:ANNE
Last Name:SELL
Suffix:
Gender:F
Credentials:LPC, CSAC, CSC-IT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4909
Mailing Address - Country:US
Mailing Address - Phone:920-486-1373
Mailing Address - Fax:
Practice Address - Street 1:705 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4909
Practice Address - Country:US
Practice Address - Phone:920-486-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15409-132101YA0400X
WI15391-133101YA0400X
WI4415-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)