Provider Demographics
NPI:1497312391
Name:WADDELL, TEMPIA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:TEMPIA
Middle Name:
Last Name:WADDELL
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:TEMPIA
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7017 MCVAY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8718
Mailing Address - Country:US
Mailing Address - Phone:901-210-1010
Mailing Address - Fax:
Practice Address - Street 1:3160 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0401
Practice Address - Country:US
Practice Address - Phone:901-210-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4168101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor