Provider Demographics
NPI:1467631499
Name:PARNELL, TERESA FAYE (PSYD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:FAYE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W SYBELIA AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4738
Mailing Address - Country:US
Mailing Address - Phone:407-862-2722
Mailing Address - Fax:407-831-1252
Practice Address - Street 1:121 W SYBELIA AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4738
Practice Address - Country:US
Practice Address - Phone:407-862-2722
Practice Address - Fax:407-831-1252
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist