MEDICARE: TERESA COSTELLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215737374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA COSTELLO

Provider Business Mailing Address
First Line	:	1101 W 40TH ST UNIT 2225
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37409-1379
Country	:	US
Telephone Number	:	877-358-2998
Fax Number	:	423-405-6346

Provider Business Practice Location Address
First Line	:	7 N TUXEDO AVE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37411-3728
Country	:	US
Telephone Number	:	877-358-2998
Fax Number	:	423-405-6346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	12/29/2025

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Directions to “ TERESA COSTELLO ” Practice Location

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