MEDICARE: JAYLA MI'ONNA TERRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1063301489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLA MI'ONNA TERRELL

Provider Business Mailing Address
First Line	:	13973 FARMINGTON RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-5403
Country	:	US
Telephone Number	:	313-575-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	14622 HEYDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-2168
Country	:	US
Telephone Number	:	313-575-2013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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Directions to “ JAYLA MI'ONNA TERRELL ” Practice Location

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