Provider Demographics
NPI:1699081729
Name:SMITH, TERRELL SPILLER (MA, LPC, LISAC)
Entity type:Individual
Prefix:MRS
First Name:TERRELL
Middle Name:SPILLER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD
Mailing Address - Street 2:#150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6130
Mailing Address - Country:US
Mailing Address - Phone:480-239-4330
Mailing Address - Fax:
Practice Address - Street 1:11000 N SCOTTSDALE RD
Practice Address - Street 2:#150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6130
Practice Address - Country:US
Practice Address - Phone:480-239-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12235 LISAC-1330101Y00000X
AZLISAC-1330101YA0400X
AZLPC-12235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101Y00000XMedicare UPIN
AZ101Y00000XMedicare PIN