Healthcare Provider Details

I. General information

NPI: 1215105184
Provider Name (Legal Business Name): MICHAEL TERRILLION LCSW, LPC, CEAP, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28071 MAIN STREET
LACOMBE LA
70445-0943
US

IV. Provider business mailing address

28071 MAIN ST
LACOMBE LA
70445-6433
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-2625
  • Fax: 985-882-6014
Mailing address:
  • Phone: 985-264-2625
  • Fax: 985-882-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3058
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8062
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: