Provider Demographics
NPI:1407627185
Name:FADELLE, MARTEN A (MMFT)
Entity Type:Individual
Prefix:
First Name:MARTEN
Middle Name:A
Last Name:FADELLE
Suffix:
Gender:M
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 MANLEY LN E
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5501
Mailing Address - Country:US
Mailing Address - Phone:615-878-7662
Mailing Address - Fax:
Practice Address - Street 1:7101 PEACH CT STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5279
Practice Address - Country:US
Practice Address - Phone:615-212-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist