Traci Terrill

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

AMFT117334 Issued in CA

Practice address

1759 N Easterly Ter
Los Angeles, CA 90026-1312

Phone

(718) 812-1269

NPI assigned

Mar 18, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 24, 2024 through Apr 24, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1881270197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1759 N EASTERLY TER",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900261312",
            "telephone_number": "718-812-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 N EASTERLY TER",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900261312",
            "telephone_number": "718-812-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRILL",
        "first_name": "TRACI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-18",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT117334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://secondchancescounseling.com/",
            "affiliation": "Y",
            "endpointDescription": "Second Chances Counseling",
            "affiliationName": "Second Chances Counseling",
            "address_1": "3575 Cahuenga Blvd W",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900681366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Makayla Terrell
• Michal Jackson Terrell, LMFT
• Tierra Terrell
• Terrence Kim MD a Medical
• Terrill Haws Family Medicine Clinic Inc
• Terrin E. Martin, M.D., a Medical Corp
• Sarahy Terriquez
• Mary Carol Territo, MD
• Christine Terrones, ANP-C
• Elizabeth Jerison Terry, PH.D.

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.