Damon Renard Terrell, LICENSED PROFESSIONA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401010711 Issued in MI

Practice address

22350 Lucerne Drive
Apt 201
Southville, MI 48075

Phone

(313) 433-1174

NPI assigned

Jul 13, 2015

Last updated

Jul 13, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Lakes Clinical Care Services LLC

  • Community/Behavioral Health Agency
  • Southfield, MI
  • NPI 1437522596
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436745600000",
    "number": "1649654336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22350 LUCERNE DRIVE",
            "address_2": "APT 201",
            "city": "SOUTHFIEILD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "313-433-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22350 LUCERNE DRIVE",
            "address_2": "APT 201",
            "city": "SOUTHVILLE",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "313-433-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRELL",
        "first_name": "DAMON",
        "middle_name": "RENARD",
        "name_prefix": "Mr.",
        "credential": "LICENSED PROFESSIONA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401010711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.