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General NPI Number Information
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NPI Number | 1376175026
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Entity Type | Individual
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Provider Name | TENISHA PETTUS MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 1533 SUNSET DR STE 225
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City | CORAL GABLES
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State | FL
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Zip | 33143-5700
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Country | US
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Telephone | 786-733-6422
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Fax |
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Provider Business Mailing Address
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Address Line | 9721 NW 3RD ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6207
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Country | US
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Telephone | 786-300-6778
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT4181
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License Number State | FL
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