Provider Demographics
NPI:1861037657
Name:ROACH, HANLEY TESTERMAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:HANLEY
Middle Name:TESTERMAN
Last Name:ROACH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FOREST CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5078
Mailing Address - Country:US
Mailing Address - Phone:865-588-9919
Mailing Address - Fax:865-909-0422
Practice Address - Street 1:111 FOREST CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5078
Practice Address - Country:US
Practice Address - Phone:865-588-9919
Practice Address - Fax:865-909-0422
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist