Provider Demographics
NPI:1962925578
Name:PETERSON, TARYN JOY (LMFT)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:JOY
Last Name:PETERSON
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N MOUNT JULIET RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4296
Mailing Address - Country:US
Mailing Address - Phone:615-492-9265
Mailing Address - Fax:615-941-2334
Practice Address - Street 1:2055 N MOUNT JULIET RD STE 204
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4296
Practice Address - Country:US
Practice Address - Phone:615-492-9265
Practice Address - Fax:615-941-2334
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist