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General NPI Number Information
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NPI Number | 1306108089
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Entity Type | Individual
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Provider Name | TERI LYNN GAETHE LPC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 2130 GOVERNMENT STREET STE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-4459
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Country | US
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Telephone | 614-477-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 3023 TRENTWOOD DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 614-477-5467
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2073
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License Number State | MS
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