Provider Demographics
NPI:1598162760
Name:MAELOUISE TENNANT, PH.D.
Entity Type:Organization
Organization Name:MAELOUISE TENNANT, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAELOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-707-0737
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33402
Mailing Address - Country:US
Mailing Address - Phone:561-707-0737
Mailing Address - Fax:
Practice Address - Street 1:210 JUPITER LAKES BLVD., BLDG. 4000, STE. 201
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-707-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty