Provider Demographics
NPI:1932831179
Name:TERRELL, ALEXIS KAITLYNN
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAITLYNN
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 1:1400 N NORMA ST STE 125
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2577
Mailing Address - Country:US
Mailing Address - Phone:760-499-2022
Mailing Address - Fax:
Practice Address - Street 1:1400 N NORMA ST STE 125
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2577
Practice Address - Country:US
Practice Address - Phone:760-499-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health