Provider Demographics
NPI:1427450758
Name:ANDERSON, TENNILLE (MENTAL HEALTH STUDEN)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MENTAL HEALTH STUDEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 THOMAS S BOYLAND ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4127
Mailing Address - Country:US
Mailing Address - Phone:917-554-9904
Mailing Address - Fax:
Practice Address - Street 1:249 THOMAS S BOYLAND ST APT 7F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4127
Practice Address - Country:US
Practice Address - Phone:917-554-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health