Provider Demographics
NPI:1265967186
Name:TENNIE, THELMA ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:THELMA
Middle Name:ELIZABETH
Last Name:TENNIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:ELIIZABETH
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:3890 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3319
Mailing Address - Country:US
Mailing Address - Phone:954-644-9567
Mailing Address - Fax:954-982-2799
Practice Address - Street 1:4699 N STATE ROAD 7 STE B1
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5870
Practice Address - Country:US
Practice Address - Phone:954-644-9567
Practice Address - Fax:954-982-2799
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3414106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist