Provider Demographics
NPI:1912364431
Name:EARLE, MARITA BETH (LMFT)
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:BETH
Last Name:EARLE
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 1:202 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2317
Mailing Address - Country:US
Mailing Address - Phone:615-498-4195
Mailing Address - Fax:
Practice Address - Street 1:202 CHERRY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2317
Practice Address - Country:US
Practice Address - Phone:615-498-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000000761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist