Provider Demographics
NPI:1942693932
Name:PRENDES-WALLS, TERESA (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PRENDES-WALLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010B 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2303
Mailing Address - Country:US
Mailing Address - Phone:917-710-4955
Mailing Address - Fax:
Practice Address - Street 1:2828 OLD HICKORY BLVD APT 1809
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-3727
Practice Address - Country:US
Practice Address - Phone:917-710-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional