Provider Demographics
NPI:1447796669
Name:BROOKER, TERESA (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BROOKER
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COWARTSIDE ALY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-2447
Mailing Address - Country:US
Mailing Address - Phone:470-322-5345
Mailing Address - Fax:615-460-4202
Practice Address - Street 1:217 COWARTSIDE ALY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-2447
Practice Address - Country:US
Practice Address - Phone:470-322-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009324101YP2500X
TN000525441101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3397960Medicaid