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General NPI Number Information
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NPI Number | 1053817254
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Entity Type | Individual
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Provider Name | TERESA CARMEL MCKENNA MS
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 9105 SHADOW POND CT
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City | ODESSA
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State | FL
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Zip | 33556-3148
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Country | US
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Telephone | 813-297-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 9105 SHADOW POND CT
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City | ODESSA
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State | FL
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Zip | 33556-3148
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Country | US
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Telephone | 813-297-8331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH18209
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License Number State | FL
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