Provider Demographics
NPI:1548795164
Name:OBEIDALLA, TEAH
Entity Type:Individual
Prefix:
First Name:TEAH
Middle Name:
Last Name:OBEIDALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 JASON MAXWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2018
Mailing Address - Country:US
Mailing Address - Phone:931-359-1197
Mailing Address - Fax:
Practice Address - Street 1:1600 JASON MAXWELL BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2018
Practice Address - Country:US
Practice Address - Phone:931-359-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-23-65048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst