Provider Demographics
NPI:1538622329
Name:TETER, JESSICA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:TETER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MEIGS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6272
Mailing Address - Country:US
Mailing Address - Phone:615-809-5236
Mailing Address - Fax:
Practice Address - Street 1:805 S CHURCH ST STE 20
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-5297
Practice Address - Country:US
Practice Address - Phone:615-809-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker