Provider Demographics
NPI:1376175026
Name:PETTUS, TENISHA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:PETTUS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6207
Mailing Address - Country:US
Mailing Address - Phone:786-300-6778
Mailing Address - Fax:
Practice Address - Street 1:1533 SUNSET DR STE 225
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5700
Practice Address - Country:US
Practice Address - Phone:786-733-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4181106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist