MEDICARE: TENELLE ODESSSA JONES LMFT, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1210025	SC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	604	SC
3	106H00000X	Marriage & Family Therapist	4509	SC

General Provider Information

NPI Number	:	1992149942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENELLE ODESSSA JONES LMFT, LAC

Provider Business Mailing Address
First Line	:	149 WOODWARD RD
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-7768
Country	:	US
Telephone Number	:	843-364-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-6523
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/23/2021

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