Provider Demographics
NPI:1952708240
Name:TERRELL, MISTY (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 CENTER LAKE DR
Mailing Address - Street 2:APT 613
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12800 CENTER LAKE DR
Practice Address - Street 2:APT 613
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1082
Practice Address - Country:US
Practice Address - Phone:512-590-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst