Healthcare Provider Details

I. General information

NPI: 1447796669
Provider Name (Legal Business Name): TERESA BROOKER EDS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 COWARTSIDE ALY
CHATTANOOGA TN
37408-2447
US

IV. Provider business mailing address

217 COWARTSIDE ALY
CHATTANOOGA TN
37408-2447
US

V. Phone/Fax

Practice location:
  • Phone: 470-322-5345
  • Fax:
Mailing address:
  • Phone: 470-322-5345
  • Fax: 615-460-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009324
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number000525441
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: