MEDICARE: JUDY S. TERRELL, LMFT, PA

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	106H00000X	Marriage & Family Therapist	1007	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140Y9	OTHER	NC	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285766725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDY S. TERRELL, LMFT, PA

Provider Business Mailing Address
First Line	:	2711 E FAIRWAY RD
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4932
Country	:	US
Telephone Number	:	252-240-3096
Fax Number	:	252-240-0458

Provider Business Practice Location Address
First Line	:	1205 ARENDELL ST STE C
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4162
Country	:	US
Telephone Number	:	252-727-5525
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JUDY S. TERRELL
Credential	:	L.M.F.T.
Telephone Number	:	252-422-2403

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	08/22/2020

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