MEDICARE: MRS. WILMA I TERRILL M.S., LMFT

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	MFC 37977	CA

General Provider Information

NPI Number	:	1518018381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WILMA I TERRILL M.S., LMFT

Provider Business Mailing Address
First Line	:	13793 RACCOON MTN.RD.
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945
Country	:	US
Telephone Number	:	530-477-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PROVIDENCE MINE RD
Second Line	:	SUITE 104 A
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2941
Country	:	US
Telephone Number	:	530-265-3068
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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