Provider Demographics
NPI:1992761225
Name:TERRILL, MARILYN J (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:J
Last Name:TERRILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 LOVERS LN
Mailing Address - Street 2:TRESTLEWOOD BLDG. D
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1558
Mailing Address - Country:US
Mailing Address - Phone:269-388-3939
Mailing Address - Fax:269-388-2346
Practice Address - Street 1:5100 LOVERS LN
Practice Address - Street 2:TRESTLEWOOD BLDG. D
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49002-1558
Practice Address - Country:US
Practice Address - Phone:269-388-3939
Practice Address - Fax:269-388-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301005326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC94575Medicare UPIN