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General NPI Number Information
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NPI Number | 1811539307
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Entity Type | Individual
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Provider Name | BAILEY TERRELL
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Gender | Female
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 408 N 1ST ST
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City | GLENWOOD
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State | AR
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Zip | 71943-9250
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Country | US
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Telephone | 870-356-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 201 REGENCY PKWY
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City | MANSFIELD
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State | TX
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Zip | 76063-5638
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Country | US
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Telephone | 682-400-0305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-101561
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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