Provider Demographics
NPI:1659265643
Name:WHITTED, TENIAL (SUPERVISED)
Entity type:Individual
Prefix:
First Name:TENIAL
Middle Name:
Last Name:WHITTED
Suffix:
Gender:F
Credentials:SUPERVISED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S MICHIGAN AVE UNIT 619
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4690
Mailing Address - Country:US
Mailing Address - Phone:708-275-9391
Mailing Address - Fax:
Practice Address - Street 1:1620 S MICHIGAN AVE UNIT 619
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4690
Practice Address - Country:US
Practice Address - Phone:708-275-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist