Provider Demographics
NPI:1285254649
Name:FLEMING, TERYL L (MED)
Entity type:Individual
Prefix:
First Name:TERYL
Middle Name:L
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:TERYL
Other - Middle Name:L
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:2091 SPRINGDALE LN APT A312
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1948
Mailing Address - Country:US
Mailing Address - Phone:615-289-4089
Mailing Address - Fax:
Practice Address - Street 1:115 HAZEL PATH STE 2
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3817
Practice Address - Country:US
Practice Address - Phone:615-289-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor