Provider Demographics
NPI:1235923038
Name:TERRELL, MYRON
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:TERRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 SILVERCHASE CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-7658
Mailing Address - Country:US
Mailing Address - Phone:678-852-2967
Mailing Address - Fax:
Practice Address - Street 1:2850 JOHNSON FERRY RD STE 200250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5684
Practice Address - Country:US
Practice Address - Phone:678-691-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health