Provider Demographics
NPI:1831846799
Name:HARRELL, BILLY
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:HARRELL
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 1:706 TURNBULL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6476
Mailing Address - Country:US
Mailing Address - Phone:407-440-0500
Mailing Address - Fax:
Practice Address - Street 1:706 TURNBULL AVE STE 104
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6476
Practice Address - Country:US
Practice Address - Phone:407-440-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician