Basic Information
| Provider Information | |||||||||
| NPI: | 1205329091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRELL | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6009 FINANCIAL PLZ STE 105 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711292615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186708858 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6009 FINANCIAL PLZ STE 105 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711292615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186708858 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2018 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 14706 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.