MEDICARE: COURTNEY 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	101YM0800X	Mental Health Counselor	39003752A	IN

General Provider Information

NPI Number	:	1114549615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY TERRELL

Provider Business Mailing Address
First Line	:	1118 N AUDUBON RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3116
Country	:	US
Telephone Number	:	317-414-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 N AUDUBON RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3116
Country	:	US
Telephone Number	:	317-414-6909
Fax Number	:

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

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/07/2020

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Directions to “ COURTNEY TERRELL ” Practice Location

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