Provider Demographics
NPI:1285766725
Name:JUDY S. TERRELL, LMFT, PA
Entity type:Organization
Organization Name:JUDY S. TERRELL, LMFT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:252-422-2403
Mailing Address - Street 1:2711 E FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4932
Mailing Address - Country:US
Mailing Address - Phone:252-240-3096
Mailing Address - Fax:252-240-0458
Practice Address - Street 1:1205 ARENDELL ST STE C
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4162
Practice Address - Country:US
Practice Address - Phone:252-727-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140Y9OtherBCBS PROVIDER NUMBER
NC6105095Medicaid