Provider Demographics
NPI:1164811055
Name:SHERA THIELE
Entity Type:Organization
Organization Name:SHERA THIELE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERA
Authorized Official - Middle Name:H
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-MHSP
Authorized Official - Phone:615-361-0052
Mailing Address - Street 1:2711 MURFREESBORO PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2000
Mailing Address - Country:US
Mailing Address - Phone:615-361-0052
Mailing Address - Fax:
Practice Address - Street 1:2711 MURFREESBORO PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2000
Practice Address - Country:US
Practice Address - Phone:615-361-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty