Provider Demographics
NPI:1861532202
Name:HERRELL, TONYA LYNN (LPE)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:HERRELL
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:MISS
Other - First Name:TONYA
Other - Middle Name:LYNN
Other - Last Name:SISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPE
Mailing Address - Street 1:214 ROLLING ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-8921
Mailing Address - Country:US
Mailing Address - Phone:615-672-2631
Mailing Address - Fax:
Practice Address - Street 1:1201 VILLA PL
Practice Address - Street 2:SUITE 207
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3014
Practice Address - Country:US
Practice Address - Phone:615-321-4477
Practice Address - Fax:615-297-6078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPE0000011663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health