Provider Demographics
NPI:1942493168
Name:TERRELL, JOHN ELLIS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELLIS
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4860 ROBB ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2184
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:334 E COURT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3412
Practice Address - Country:US
Practice Address - Phone:502-609-2089
Practice Address - Fax:812-280-0222
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2013-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN20042036A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20042036AOtherPROFESSIONAL LICENSE