Healthcare Provider Details

I. General information

NPI: 1720931033
Provider Name (Legal Business Name): TERRELL JOHNSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 EDINBROOK XING STE 211
BROOKLYN PARK MN
55443-2060
US

IV. Provider business mailing address

PO BOX 32227
MINNEAPOLIS MN
55432-0227
US

V. Phone/Fax

Practice location:
  • Phone: 612-567-2770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TERRELL JOHNSON
Title or Position: SOCIAL WORKER
Credential: LICSW
Phone: 612-567-2770